Journal Article

Retained guidewire mimicking an aortic intimal flap diagnosed with point-of-care ultrasound – A case report and review of the literature

Gold, Daniel D., Muhtaseb, Osama

2025

Overview

Isolated abdominal aortic dissection is a rare but potentially fatal condition. Timely diagnosis and management are crucial to reduce mortality and possible complications. Though computed tomography (CT) is the diagnostic imaging modality of choice, point-of-care ultrasound (PoCUS) holds certain promises in diagnosing aortic dissection. PoCUS is readily available at the bedside, has high specificity and sensitivity, and is useful, especially in unstable cases or when advanced imaging access is limited or time-consuming. PoCUS can also aid in risk stratification and assist in clinical decision-making when the likelihood of diagnosis is low. We describe a case of a 56-year-old patient who was referred to us with suspected abdominal aortic dissection, initially identified on an outpatient ultrasound. PoCUS performed in the emergency department (ED) revealed findings inconsistent with an intimal flap but more suggestive of a retained foreign body. The diagnosis was subsequently confirmed by a CT scan, which demonstrated a retained guidewire inadvertently left in place during a coronary intervention performed a decade earlier.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abdomen / Abdominal aortic dissection / Aortic Aneurysm, Abdominal - diagnostic imaging / Aortic Dissection - diagnostic imaging / Computed tomography / Decision making / Diagnosis / Diagnosis, Differential / Dissection / Emergency / Emergency medical care / Emergency Service, Hospital / Emergency ultrasound / Foreign Bodies - diagnostic imaging / Humans / Literature reviews / Male / Middle Aged / Mortality / PoCUS / Point of care testing / Point-of-Care Systems / Retained guidewire / Tomography, X-Ray Computed / Ultrasonography / Ultrasound