Aortic Dissection Presenting as Shortness of Breath from Diffuse Alveolar Hemorrhage

Joya Singh, Deven Bhatia, Dazhe James Cao, Jonathan Brewer, Lynn Roppolo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Aortic dissection is a rare but well-known life-threatening disease that classically presents with tearing chest pain radiating to the back yet can have deceiving clinical presentations. Case Report: A 54-year-old man with a history of hypertension presented to the emergency department with mild shortness of breath without chest pain. Point-of-care ultrasound (POCUS) detected diffuse B-lines, a dilated aortic root, aortic regurgitation, and pericardial effusion. A computed tomography angiogram confirmed a Stanford type A aortic dissection with diffuse alveolar hemorrhage (DAH), a rare complication of type A aortic dissection involving the posterior aortic wall with extension into the main pulmonary artery. Why Should an Emergency Physician Be Aware of This?: Acute aortic dissection can present with a wide range of clinical manifestations with a high mortality rate for patients with an untimely diagnosis. Although an intimal flap within the aortic lumen is the characteristic finding on ultrasound, additional POCUS findings of a pericardial effusion, aortic regurgitation, and a dilated aortic root may be seen with proximal dissections. Diffuse B-lines on thoracic POCUS, although commonly associated with pulmonary edema in decompensated heart failure, can be seen in patients with DAH which has a multitude of etiologies, including aortic dissection.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - 2022

Keywords

  • Aortic dissection
  • B lines
  • Case report
  • Diffuse alveolar hemorrhage
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine

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