POCUS – Type B Aortic Dissection

Point-of-care ultrasound (POCUS) can be a quick and noninvasive modality to confirm a concerning pathology like type B aortic dissection. As a CVICU intensivist, I often receive transfers for “aortic dissection” from other hospitals based on suboptimal imaging. However, they’re sometimes found to be other acute aortic syndromes like intramural hematoma.

A Stanford type B aortic dissection occurs when a tear occurs in the aorta’s inner layer – the tunica intima – in the descending aorta. From the subcostal IVC long-axis view, tilt the phased array beam to the patient’s left to reveal the abdominal aorta. The video shows a linear density in the aorta consistent with a type B aortic dissection flap. Furthermore, color-flow Doppler shows flow isolated to the true lumen. I can spend a few more seconds assessing flow down the major visceral vessels like the celiac plexus and superior mesenteric artery which may help determine which patients are better suited for medical management versus an intervention.

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