Point-of-care ultrasound in the diagnosis of extensive stanford type a aortic dissection in a low-resource setting: a case report

Acute aortic dissection (AAD) carries high early mortality and is frequently misdiagnosed, particularly in resource-limited settings where computed tomography angiography (CTA) is inaccessible and atypical presentations are common. Point-of-care ultrasound (POCUS) has emerged as a critical first-line diagnostic adjunct, yet documented experience from West African emergency departments is virtually absent. To our knowledge, this is the first reported case of emergency physician-performed POCUS leading to the diagnosis of aortic dissection in a Ghanaian emergency department. A 74-year-old Ghanaian man with newly diagnosed hypertension presented to the emergency department (ED) of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, with a two-week history of atypical central chest pain, palpitations, and exertional fatigue — without the classical abrupt tearing onset. Bedside POCUS was performed using the Sonographic Protocol for the Emergent Evaluation of Aortic Dissections (SPEED) framework, incorporating parasternal, subxiphoid, and abdominal aortic windows. POCUS demonstrated marked aortic dilatation (5.21–6.35 cm across multiple views) and a visible mobile intimal flap with true and false lumen separation. CTA confirmed extensive Stanford type A (DeBakey I) aortic dissection from the aortic root through the thoracoabdominal aorta into the right common iliac artery, with giant aneurysmal dilatation (aortic root 80 mm) and branch-vessel involvement. A mildly elevated troponin I (0.08 ng/mL) was correctly attributed to aortic root involvement rather than primary acute coronary syndrome, based on a normal ECG and overall clinical context. Definitive open surgical repair was not feasible due to local infrastructure limitations. Anti-impulse therapy was initiated and the patient was discharged haemodynamically stable after 12 days, remaining well at 30-day follow-up. This case highlights the atypical presentation of Stanford type A aortic dissection as a critical diagnostic pitfall, and demonstrates how structured risk stratification (ADD-RS) combined with bedside POCUS using the SPEED protocol enabled timely diagnosis in a resource-limited West African emergency department. It underscores that POCUS is an indispensable first-line tool for acute aortic syndrome where advanced imaging is inaccessible, and highlights a persistent diagnostic-therapeutic gap: the capacity to diagnose now outpaces the surgical infrastructure to treat.