PMC9592206_01
Parasternal long axis view of the heart displaying a pericardial effusion with dilated aortic root, concerning for aortic root dissection. LV: left ventricle; LVOT: left ventricular outflow tract; PCE: pericardial effusion.
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This revealed a pericardial effusion and dilated aortic root (Figure 1).
CT imaging with 6.6 cm aneurysm of the ascending thoracic aorta without dissection. Large pericardial effusion.
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The patient was stable enough for CT scan at this time, which also demonstrated a pericardial effusion and a 6.6-centimeter ascending thoracic aortic aneurysm but no CT evidence of aortic dissection (Figure 2).
Parasternal long axis view of the heart, demonstrating a dilated aortic outflow tract measuring 6.62 cm during diastole. Normal size of the aortic outflow tract is less than 4 cm.
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After returning to the ED from CT scan, point-of-care transthoracic echocardiogram was repeated, which showed a larger pericardial effusion with tamponade physiology, dilated aortic root measuring 6.62-centimeter (Figure 3), an intimal flap within the left ventricular outflow tract (Figure 4), aortic regurgitation demonstrated on velocity time integrals (Figure 5), and color flow Doppler (Figure 6).
Parasternal long axis displaying the intimal flap within the aortic outflow tract. LA: left atrium; LV: left ventricle; RV: right ventricle; PCE: pericardial effusion; LVOT: left ventricular outflow tract.
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After returning to the ED from CT scan, point-of-care transthoracic echocardiogram was repeated, which showed a larger pericardial effusion with tamponade physiology, dilated aortic root measuring 6.62-centimeter (Figure 3), an intimal flap within the left ventricular outflow tract (Figure 4), aortic regurgitation demonstrated on velocity time integrals (Figure 5), and color flow Doppler (Figure 6).
Velocity time integral (VTI) demonstrating aortic regurgitation. The negative deflections show the normal forward flow of blood through the aortic valve, but the presence of positive deflections show the regurgitant flow.
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After returning to the ED from CT scan, point-of-care transthoracic echocardiogram was repeated, which showed a larger pericardial effusion with tamponade physiology, dilated aortic root measuring 6.62-centimeter (Figure 3), an intimal flap within the left ventricular outflow tract (Figure 4), aortic regurgitation demonstrated on velocity time integrals (Figure 5), and color flow Doppler (Figure 6).
Color flow Doppler demonstrating regurgitant flow through the aortic valve, which has retracted back into the left ventricle because of the aortic root dissection.
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After returning to the ED from CT scan, point-of-care transthoracic echocardiogram was repeated, which showed a larger pericardial effusion with tamponade physiology, dilated aortic root measuring 6.62-centimeter (Figure 3), an intimal flap within the left ventricular outflow tract (Figure 4), aortic regurgitation demonstrated on velocity time integrals (Figure 5), and color flow Doppler (Figure 6).