Emergency Ultrasound : answer to case of the month september 2013

22 Sep

ANSWER to the ultrasound case of the month september 2013:

This case is brought to you by Nasim Azizi, emergency physician and hardcore ultrasound fanatic. Enjoy !

50 yr male brought to my ED in the UMCG Groningen by ambulance. He woke up with a crushing chest pain radiating to left arm en neck.
Cardiovascular risk factors ; hypercholesterolaemia, obesitas , smoking. No other past medical history.

According to protocol the ambulance personnel already had given him ASA

Vitals coming in to the ED  : 85/50 mmHg  , 78/min ,  97 % on room air

He is sweating ,clammy and anxious.

His EKG shows SR 78/min no signs of ischaemia

1) What is your most likely diagnosis ?

2) What would you do next ?

– Send him for PCI

– Wait for the troponine ….

-…..

While the patient gets some fluids  I did an emergency cardiac ultrasound .

Whats your diagnosis now ? ( this not the textbook quality images you are used to , but this is the real stuff ;-))

US00006Swatch clip

ANSWER :

Ultrasound : Clip, subcostal view: Pericardial fluid with tamponade physiology , Image, parasternal long axis :widened aortic root measuring 4.5 cm.

Diagnosis :    Type A dissection with tamponade , later to be confirmed with CTA

Patient was brougth to the OR, treated succesfully and discharged from hospital after one week.

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