POCUS in the Rapid Diagnosis of Aortic Dissection in the Emergency Department: Case Report

Abstract

Background: Aortic dissection is a life-threatening condition that requires timely diagnosis and intervention. However, its variable presentation often leads to delayed recognition in the emergency department (ED). Point-of-care ultrasound (POCUS), when performed by a nurse practitioner, can serve as a valuable bedside tool for the rapid assessment of patients with suspected aortic dissection, particularly in cases with atypical presentations.

Case Presentation: We describe the case of a 91-year-old male presenting to the ED for syncope. Initial assessment was challenging due to the patient’s altered mental status and atypical presentation. POCUS, performed during the initial clinical evaluation, revealed a dilated aortic root and an intimal flap, raising suspicion for an acute aortic dissection. This prompted urgent confirmatory imaging with computed tomography angiography (CTA), which confirmed a Stanford Type A aortic dissection extending into the great vessels.

Discussion: This case highlights the role of POCUS in the early detection of aortic dissection, particularly when clinical presentation is nonspecific. While CTA remains the gold standard for diagnosis, POCUS offers a rapid, non-invasive means of identifying key findings such as aortic dilation, pericardial effusion and intimal flaps, facilitating early decision-making in critical patients.

Conclusion: POCUS is a valuable adjunct in the evaluation of suspected aortic dissection, allowing for timely diagnosis and intervention. Increased awareness and training in its application may enhance ED clinicians’ ability to recognize and manage this life-threatening condition more effectively.