Pericarditis masking a localised thoracic aorta dissection: Making a point for point-of-care ultrasound

Abstract

Early detection of aortic dissection (AD) remains essential due to high mortality rates. We report a case of localised thoracic AD initially misdiagnosed as pericarditis, but subsequently diagnosed through point-of-care ultrasound (POCUS). A 35-year-old gentleman presented with sudden-onset jaw and chest pain. An initial electrocardiogram revealed changes consistent with pericarditis, and high-sensitive troponin levels on admission were not raised. An initial diagnosis of pericarditis was made. However, due to persistent symptoms despite treatment, an urgent POCUS was performed, revealing a prominently dilated aortic root, with evidence of an intimal flap near the coronary cusps. Computed tomography imaging revealed a focal aortic root dissection confined within the sinus of Valsalva, with no involvement of coronary arteries or descending thoracic or abdominal aorta. This case highlights how commonly a misdiagnosis of AD can occur and how concurrent pericarditis can often mask AD. Our report highlights the need for better incorporation of POCUS in the initial assessment of acute chest pain, as studies have shown both high sensitivity and specificity in diagnosing AD, with no additional burden on treatment start-up time and mortality.