Common Iliac Artery Tortuosity Simulating Aortic Dissection on Focused Abdominal Ultrasound in the Emergency Department

Background

Bedside ultrasonography performed by the Emergency Physician is a safe procedure for evaluating patients with trauma, hypotension, chest or abdominal pain, and dyspnea of unknown origin.

Objectives

To present a case with apparent concordance between the patient's history, symptoms, signs, and ultrasound imaging, that lead to diagnostic error.

Case Report

A 74-year-old man was admitted to the hospital due to epigastric pain, radiating to the back. He reported previous detection of a small dilatation in the ascending aorta. On physical examination, the heart rate was 120 beats/min and the blood pressure was 90/60 mm Hg. These facts suggested the possibility of an aortic dissection; therefore, a bedside emergency ultrasound examination was performed. The first part of the examination focused on the ascending aorta, but the results were not significant. Then, an abdominal evaluation was performed that revealed an ovular and pulsatile anechoic mass in the infrarenal tract, with an echoic wall and an endoluminal flap. A computed tomography scan of the aorta was ordered, and it showed a regular aorta in the entire tract, with an abnormal tortuosity of iliac arteries as the basis of the false-positive ultrasound.

Conclusions

The use of ultrasound in emergency settings has improved the clinical evaluation of critical patients by Emergency Physicians, but the possibility of a false-positive diagnostic error always should be considered.