Backlund Brandon, Kendrick-Adey Anastasia, Harper Rachel, Makela Martin
University of Washington, Department of Emergency Medicine, Seattle, WA.
J Educ Teach Emerg Med. 2020 Apr 15;5(2):V14-V18. doi: 10.21980/J8WW6W. eCollection 2020 Apr.
Aortic dissection is a life-threatening, time-sensitive emergency. Conventional diagnostic imaging modalities such as computed tomography (CT) can be time-consuming to obtain, and require that the patient leave the emergency department (ED); as such, they are unsuitable for unstable patients. Emergency focused transthoracic echocardiography (ETTE) is commonly performed in the ED as part of the evaluation of a patient presenting with chest pain, but the suprasternal notch view (SSNV) is much less well-known and infrequently included in this assessment. We present a case of a 51-year-old previously healthy man who presented to the ED complaining of chest pain that had resolved prior to arrival, and a mild headache. His vital signs were notable for hypotension, but physical exam was unremarkable. Chest x-ray revealed a borderline widened mediastinum. A standard ETTE was within normal limits, but additional SSNV demonstrated a dissection flap in the aortic arch. The patient was taken to the operating room for surgical repair 75 minutes after the ED ultrasound was performed; the operation was successful, and the patient was discharged to home post-operatively with good outcome. Standard ETTE has limited ability to visualize the ascending aorta and aortic arch. Addition of SSNV allows visualization of these structures and may improve diagnostic accuracy and time to diagnosis of proximal aortic dissection.
Aortic dissection, emergency echocardiography, point-of-care ultrasound, POCUS, emergency ultrasound, suprasternal notch view.
主动脉夹层是一种危及生命、对时间敏感的急症。传统的诊断成像方式，如计算机断层扫描（CT），获取结果可能耗时较长，且需要患者离开急诊科（ED）；因此，它们不适合不稳定的患者。急诊床旁经胸超声心动图（ETTE）在急诊科常用于对胸痛患者进行评估，但胸骨上切迹视图（SSNV）鲜为人知，在该评估中也很少被采用。我们报告一例51岁既往健康男性，他因胸痛就诊于急诊科，胸痛在到达之前已缓解，还伴有轻度头痛。他的生命体征以低血压为显著特征，但体格检查无异常。胸部X线显示纵隔轻度增宽。标准的ETTE结果正常，但额外的SSNV显示主动脉弓有一个夹层瓣。在进行急诊超声检查75分钟后，患者被送往手术室进行手术修复；手术成功，患者术后出院，预后良好。标准的ETTE可视化升主动脉和主动脉弓的能力有限。增加SSNV可使这些结构可视化，并可能提高近端主动脉夹层的诊断准确性和诊断时间。
主动脉夹层、急诊超声心动图、床旁超声、POCUS、急诊超声、胸骨上切迹视图
