Importance of Multiple-window Assessment for the Diagnosis of Ascending Aortic Dissection Using Point-of-care Ultrasound: Report of Three Cases

Abstract

Acute ascending aortic dissection has a high mortality rate and requires rapid diagnosis and treatment. Point-of-care ultrasound (POCUS) can aid in the diagnosis. The aortic root is usually evaluated in the parasternal long-axis view; however, a dissection flap is not always visible in this projection. We present three cases of acute, type A aortic dissection in which the dissection flap was only evident in the apical five-chamber and subxyphoid views. These cases suggest that POCUS may play a pivotal role in the initial diagnosis of acute ascending aortic dissection and highlight the importance of viewing multiple windows to fully evaluate this possibility.

A man with sudden onset chest pain

“…3 Multiple transthoracic echocardiography views are recommended when assessing the thoracic aorta. 4,5 The suprasternal view is often not considered in this assessment but is of paramount importance, and it was key to diagnosis in the present case. Management of a Stanford type A dissec-tion includes the control of blood pressure and heart rate and consultation for emergency surgery.…”

“…POCUS is efficient, highly specific, and can escalate management 3 . Multiple transthoracic echocardiography views are recommended when assessing the thoracic aorta 4,5 . The suprasternal view is often not considered in this assessment but is of paramount importance, and it was key to diagnosis in the present case.…”