Pulmonary Artery Compression Secondary to Ruptured Thoracic Aortic Dissection: A Rare Mimic of Pulmonary Embolism
Sunday, April 7, 2024
3:22pm – 3:29pm
Location: 412
Authors: Ochan Kwon, St. Barnabas Hospital Health System Alexandra Bourlas, NYP-Weill Cornell Medicine Ashley Voroba, SBH Angelo Mascia, SBH
You are working in the ED and have a patient with chest pain that quickly becomes unstable with cardiac arrest. During the resuscitation, you place the ultrasound probe on the patient’s chest. You see a large dilated right ventricle, a D-shaped left ventricle, and paradoxical septal wall motion. This is right ventricular dysfunction, or right heart strain. What are some potential causes that come to mind? Ultrasound findings of right heart strain have commonly been misconstrued to be pathognomonic for pulmonary pathology, classically PE. Here we demonstrate a case where findings of right heart strain on POCUS during cardiac arrest were not due to massive PE. While rare, complications of acute aortic syndrome such as an aortic dissection with a contained rupture can cause extrinsic compression of the pulmonary arteries leading to acute right ventricular failure, mimicking the presentation of massive PE. While these acute aortic complications are uncommon in the ED, they are associated with high in-hospital mortality and can be missed. It is important to consider a broad differential for right heart strain particularly in an unstable patient presenting with chest pain.