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Aortic Dissection

This week’s image is brought to us by Dr. Jordan Kaylor. The patient was an elderly male who presented to EUHM with persistent periumbilical abdominal pain. Dr. Kaylor performed a Point-of-care ultrasound of the abdomen and the following images were obtained:

 Image 1:

 Image 1

Image 2:

Diss_long

These images contain some key findings. As you can see on the short axis view of the aorta, it appears to be quite tortuous. A dissection flap is noted (white arrow) both in the long and short axis view of the vessel as labeled in the still images below.  

Image 3:

Aortashortstill

Image 4:

aortalongstill

Note that not all patients will have the textbook anatomy. For instance, this patient’s aorta is quite displaced in its relationship with the superior mesenteric artery (red arrow) due to its tortuosity in the short axis image provided. The ability to mentally visualize and identify structures on ultrasound is of paramount importance in accurate imaging and diagnostics. If you are lost try to orient to structures you can confidently identify (such as the spine in this image) and use that landmark to orient to less clear anatomic strutures. 

Focused ultrasonography can serve as a valuable tool in answering specific clinical questions based on history and physical examination. Our many thanks to Dr. Kaylor for these exceptional images and happy scanning everyone!

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Usama Khalid, M.D.

Emergency Ultrasound Fellow

Emory University - School of Medicine