Point of Care Echocardiography in an Acute Thoracic Dissection with Tamponade in a Young Man with Chest Pain, Tachycardia, and Fever.
BACKGROUND
Although thoracic aortic dissections are uncommon in young patients, they must be considered in the differential diagnosis in the presence of chest pain and abnormal vital signs. Although computed tomography angiography is the test of choice for thoracic dissection in the emergency department, point of care (POC) transthoracic echocardiography has a high specificity in the diagnosis of this disease. It is especially helpful in patients with proximal ascending dissections in the presence of a pericardial effusion.


METHODS
This case report illustrates a young patient presenting with chest pain, persistent tachycardia, and fever with a presumed upper respiratory infection who had an ascending thoracic dissection with tamponade discovered on POC echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POC echocardiography should be an important part of the algorithm in young patients presenting with chest pain and abnormal vital signs that do not improve with supportive measures. Definitive care in patients who present with a thoracic aortic dissection in the presence of cardiac tamponade diagnosed on POC echocardiography should not be delayed in order to wait for other imaging methods to be performed. POC echocardiography may expedite care and treatment in young patients presenting with this deadly disease.
Department of Emergency Medicine, New York University School of Medicine, New York, New York.
Kristin
K
Carmody
Department of Emergency Medicine, New York University School of Medicine, New York, New York.
Michael
M
Asaly
Department of Emergency Medicine, New York University School of Medicine, New York, New York.
Uché
U
Blackstock
D000784:Aortic Dissection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002637:Chest Pain / Q000209:etiology; D000072226:Computed Tomography Angiography / Q000379:methods; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005334:Fever / Q000503:physiopathology; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use; D013610:Tachycardia / Q000209:etiology; D013896:Thoracic Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D055815:Young Adult
D011412:Propanolamines; C036604:esmolol
echocardiography; point of care; tamponade; thoracic aortic dissection; ultrasound