Utilizzo del palmare POCUS per accelerare la diagnosi di dissezione aortica
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Abstract
Si riporta il caso di una donna di 82 anni giunta in Pronto Soccorso presentando
astenia, deficit di forza all’arto superiore sin e dolore toracico lieve.
La valutazione clinica della paziente ha incluso l’utilizzo di un device ecografico
portatile dotato di sonda sector al fine di individuare possibili cause di shock ed
ipotensione. L’esame ha permesso di evidenziare - mediante scansione al giugulo - la
presenza di flapping intimale a livello dell’arco aortico, ponendo il sospetto diagnostico
di dissezione aortica (AD) tipo A.
Il cardiochirurgo è stato immediatamente allertato, nell’attesa dell’esecuzione dell’angio-
TAC toracica (la radiografia del torace non è stata eseguita) che ha confermato il
sospetto diagnostico.
La diffusione dell’ultrasonografia “point-of-care” (POCUS) con device portatili può
migliorare ed accelerare la diagnosi di condizioni critiche quali la AD, patologia
caratterizzata da una mortalità tempo-dipendente e la cui terapia differisce totalmente
da quella di altre condizioni cliniche che può mimare.
ENG: A 82-year-old woman presented to the Emergency Department (ED) with
asthenia, neurological weakness of left arm and mild chest pain.
A portable ultrasound device equipped with a sector probe - used to assess possible causes of shock and hypotension - showed intimal flapping of aortic arc on suprasternal notch scan.
The diagnosis of type A aortic dissection (AD) was confirmed by CT scan, but in the meanwhile the cardiac surgery team had been already alerted.
The use of point-of-care ultrasonography (POCUS) with portable devices can improve and speed up the diagnosis of life threatening conditions as AD which has time related mortality and whose therapy differs from that of other conditions ti may mimics.
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