Three-dimensional echocardiographic findings in an acute anterior pericardial bleed due to acute aortic dissection: bidirectional to-and-fro flow in the upper pericardial sac.

摘要

A 62-year-old African American man awoke at four o'clock in the morning with the acute onset of substernal chest pain radiating to the back. He had used cocaine and marijuana within the last 24 hours. He presented to the emergency department approximately 2 hours later with an initial blood pressure of 194/117 mmHg and a heart rate of 69 beats per minute. A urine drug screen was positive for the presence of cocaine and marijuana. A noncontrast computed tomography scan showed aneurys-mal dilatation of the ascending aorta and a pericardial effusion.