SHM Converge Scientific Abstract ePoster Gallery-Mobile Carotid Thrombus on Bedside Pocus as the Key Clue to Extensive Carotid and Aortic Dissection

Mobile Carotid Thrombus on Bedside Pocus as the Key Clue to Extensive Carotid and Aortic Dissection

Pdf Summary

A 58-year-old man with alcohol and cannabis use was found unresponsive at home with severe hypoglycemia, elevated lactate, leukocytosis, worsening troponin, and acidosis. Initial CT head and CTA chest were nondiagnostic except for basilar opacities and an incidental ascending aortic aneurysm. He was initially hypertensive but then developed shock with tachycardia and hypotension requiring high-dose norepinephrine.<br /><br />During ultrasound-guided central line placement, a mobile intraluminal thrombus was unexpectedly seen in the right carotid artery on bedside POCUS. This prompted urgent reconsideration of the diagnosis and vascular imaging. MRI of the brain showed numerous acute and subacute infarcts in both cerebral and cerebellar hemispheres, suggesting a proximal arterial source. Repeat CTA revealed right carotid artery dissection and a type A aortic dissection extending through the ascending and descending aorta.<br /><br />The patient rapidly deteriorated and died shortly after the repeat CTA. The case highlights the diagnostic challenge of multisite arterial dissection presenting as coma and shock, especially when early findings are nonspecific. It also emphasizes the value of bedside ultrasound as an incidental but critical clue, and the importance of early vascular imaging when multiterritory cerebral infarcts or unexplained hemodynamic collapse raise concern for aortic dissection.

Asset Subtitle

Fatih B. Kaner

Meta Tag

Author List Barkha Kumari, Fatih B. Kaner, Imran Sethi, Naina Kumari

Category Clinical Vignettes

Concept Aortic Dissection

Concept Cerebral Infarction

Concept Vascular Imaging

Concept Coma

Concept Shock

Distinguished Non-Finalist

Presenter Organization Marion Health

Presenting Author Fatih B. Kaner

Track Adult

Keywords

aortic dissection

carotid artery dissection

shock

coma

hypoglycemia

bedside ultrasound

POCUS

multiterritory infarcts

vascular imaging

troponin elevation

Aortic Dissection

Cerebral Infarction

Vascular Imaging

Coma

Shock