Acute aortic syndrome and bedside ultrasonography in emergency department

Purpose: Aortic dissection is relatively rare, but may occur as a catastrophic condition for the patient's prognosis, so an early diagnosis and treatment is crucial to their survival. We used two systems of classification of this pathology, being the most used sorting Stanford: type A dissection, if it affects the ascending aorta; type B and all other types of dissection.

Material and methods: We studied the diagnosis of an aortic dissection type B of Stanford by a bedside ultrasound performed by emergency physician. We have an ultrasound-Sonosite M-Turbo, P21 probe of between 1 and 5 MHz, with and echocardiography software.

Results: A 76 years old male, admitted to the emergency room because he suffers intense, transfixing, oppressive central chest pain radiating to the back. He had normal vital signs. Analysis revealed a dimer D 6222, with normal cardiac enzymes and electrocardiogram, but showing an aortic elongation mediastinal widening on chest radiograph, so the emergency physician performed an ultrasound scan that showed a double light in the abdominal aorta, until iliac. A thoracoabdominal CT scan was immediately performed with contrast confirmed type B aortic dissection, from the left subclavian to the iliac bifurcation, with false light in a posterior position, without involvement of supra-aortic arteries and visceral branches. The patient was admitted to the ICU, opting for traditional treatment, was discharged without later complications.

Conclusions: Ultrasound has become, in the last few years, an indispensable tool for the emergency physician, and there is broad international supporting literature that recommends and requires that us, all the emergency physicians, use ultrasound for the benefit of our patients; but its use is not infallible, so performing the technique and interpretation by not medical experts, must be supervised by others with more experience to guide them so possible diagnostic errors are avoided.