Abstract
Background
Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or ‘tearing’) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases. Echocardiography has become the most commonly used imaging test for evaluating cardiovascular disease and, thus, plays an important role in aortic disease diagnosis and follow-up.
Case presentation
This paper presents the case of a 63-year-old female presenting a chronic cough for more than 30 days, accompanied by chest pain radiating to the left scapula, a history of chronic hypertension, and recent chest x-ray findings of mediastinal mass on the upper left of the aortic knob. Transthoracic echocardiography (TTE) shows a clear image of a dissection flap on the ascending aorta and abdominal aorta, with a false lumen that is larger than the true lumen and filled with intramural thrombus. A transesophageal echocardiography (TOE) examination performed later shows a clear entry tear near the sinuses of Valsalva directly above the ostium of the right coronary artery (RCA). The patient was diagnosed with AD Stanford A de Bakey Type 1. Computed tomography (CT) focusing on the thoracoabdominal aorta and coronary artery was ordered upon suspicion of RCA ostium obstruction by the dissection flap and to further direct the surgical management. However, later on, the patient refused to undergo surgery, opting instead for conservative medical therapy.
Conclusion
The diagnosis of AD is challenging. Our case emphasizes the vital role of TTE in diagnosing AD, particularly in patients with atypical symptoms in which the diagnosis of AD might not be considered. Such missed AD diagnoses can lead to precarious outcomes.
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Abbreviations
- AD:
-
Aortic dissection
- ECG:
-
Electrocardiogram
- CXR:
-
Chest X-ray
- TTE:
-
Transthoracic echocardiography
- TOE:
-
Transesophageal echocardiography
- CT:
-
Computed tomography
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RM and DNG contributed to the concept and design of article, acquisition of patient’s data, and drafting the article. EPBM and AL were involved in revising the article critically for important intellectual content.
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Supplementary Video 1. TTE suprasternal view showing the double-barrel appearance and dissection flap on the aortic arch to the descending aorta (MP4 1479 kb)
Supplementary Video 2. TOE mid-esophageal aortic valve long-axis view showing intimal tear at the sinus of Valsalva (WMV 2476 kb)
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Muhammad, R., Lefi, A., Ghassani, D.N. et al. An atypical presentation of aortic dissection: echocardiography for accurate detection. J Ultrasound 25, 737–743 (2022). https://doi.org/10.1007/s40477-021-00617-4
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DOI: https://doi.org/10.1007/s40477-021-00617-4