Gold Daniel D, Muhtaseb Osama
Emergency Department, Shaare Zedek Medical Center and Hebrew University, Faculty of Medicine, Jerusalem, Israel.
Emergency Department, Shaare Zedek Medical Center and Hebrew University, Faculty of Medicine, Jerusalem, Israel.
Am J Emerg Med. 2025 Jul;93:238.e1-238.e3. doi: 10.1016/j.ajem.2025.04.050. Epub 2025 Apr 22.
Isolated abdominal aortic dissection is a rare but potentially fatal condition. Timely diagnosis and management are crucial to reduce mortality and possible complications. Though computed tomography (CT) is the diagnostic imaging modality of choice, point-of-care ultrasound (PoCUS) holds certain promises in diagnosing aortic dissection. PoCUS is readily available at the bedside, has high specificity and sensitivity, and is useful, especially in unstable cases or when advanced imaging access is limited or time-consuming. PoCUS can also aid in risk stratification and assist in clinical decision-making when the likelihood of diagnosis is low. We describe a case of a 56-year-old patient who was referred to us with suspected abdominal aortic dissection, initially identified on an outpatient ultrasound. PoCUS performed in the emergency department (ED) revealed findings inconsistent with an intimal flap but more suggestive of a retained foreign body. The diagnosis was subsequently confirmed by a CT scan, which demonstrated a retained guidewire inadvertently left in place during a coronary intervention performed a decade earlier.
孤立性腹主动脉夹层是一种罕见但可能致命的疾病。及时诊断和治疗对于降低死亡率和可能的并发症至关重要。尽管计算机断层扫描（CT）是首选的诊断成像方式，但床旁即时超声（PoCUS）在诊断主动脉夹层方面具有一定的前景。PoCUS在床边即可使用，具有高特异性和敏感性，并且很有用，特别是在不稳定的病例中，或者当先进的成像设备难以获得、耗时较长时。当诊断可能性较低时，PoCUS还可以帮助进行风险分层并协助临床决策。我们描述了一例56岁的患者，因疑似腹主动脉夹层被转诊至我们这里，最初是在门诊超声检查中发现的。在急诊科（ED）进行的PoCUS检查结果显示与内膜瓣不一致，但更提示有异物残留。随后通过CT扫描确诊，CT显示在十年前进行的冠状动脉介入治疗期间无意中遗留了一根导丝。
