Hindawi Publishing Corporation Case Reports in Vascular Medicine Volume 2013, Article ID 490126, 3 pages http://dx.doi.org/10.1155/2013/490126 Case Report Aortic Dissection and Thrombosis Diagnosed by Emergency Ultrasound in a Patient with Leg Pain and Paralysis Ann H. Tsung, Leslie C. Nickels, Giuliano De Portu, Eike F. Flach, and Latha Ganti Stead Department of Emergency Medicine, College of Medicine, University of Florida, 1329-SW 16 Street, P.O. Box 100186, Gainesville, FL 32610, USA Correspondence should be addressed to Latha Ganti Stead; lstead@ul.edu Received 11 October 2012; Accepted 28 November 2012 Academic Editors: N. Espinola-Zavaleta, A. Hatzitolios, C.-L. Hung, L. Masotti, N. Papanas, M. Reinhard, S. Yamashiro, and R. Zbinden Copyright © 2013 Ann H. Tsung et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. he authors present a case of aortic dissection and abdominal aortic aneurysm thrombosis in a 78-year-old male who presented to the emergency department (ED) complaining of lower extremity and paralysis for the past 1.5 hours. he initial vital signs in the ED were as follows: blood pressure (BP) 132/88 mmHg, heart rate (HR) 96, respiratory rate (RR) 14, and an oxygen saturation of 94% at room air. Physical exam was notable for pale and cold let leg. he ED physician was unable to palpate or detect a Doppler signal in the let femoral artery. Bedside ultrasound was performed which showed non-pulsatile let femoral artery and limited low on color Doppler. Abdominal aortic aneurysm screening ultrasound was performed showing a 4.99cm infrarenal abdominal aortic aneurysm and an intra-aortic thrombus with an intimal lap. Vascular surgery was promptly contacted and the patient underwent emergent aorto-bi-femoral bypass, bilateral four compartment fasciotomy, right common femoral artery endarterectomy with profundoplasty, and subsequent let leg amputation. Emergency physicians should utilize bedside ultrasound in patients who present with risk factors or threatening signs and symptoms that may suggest aortic dissection or aneurysm. Bedside ultrasound decreases time to deinitive treatment and the mortality of the patients. 1. Introduction Aortic aneurysm oten goes undiagnosed and carries an extremely high mortality rate when ruptured. Here, we present a case of aortic dissection and complete infrarenal abdominal aortic aneurysm (AAA) thrombosis diagnosed by bedside ultrasound in the ED. 2. Case Report A 78-year-old Caucasian male with past medical history of chronic obstructive pulmonary disease, coronary artery disease, and peripheral vascular disease presented to the ED via helicopter for let lower extremity paralysis and a “cold extremity” that started an hour and half ago. he patient reported that he had some vague pain shortly before but now the pain was sharp and rated as 10 out of 10 on the pain scale. he patient was able to walk to the bathroom without aid this morning and is usually able to ambulate half a block before getting tired. he patient denied fever, loss of consciousness, nausea, vomiting, neck stifness, photophobia, or aura. His home medications included acetaminophen and hydrocodone. he patient had no allergies. Prior surgeries included coronary artery bypass grat and two stents. he patient had a 64 pack year smoking history and denied alcohol or drug use. he patient’s initial vital signs in the ED were as follows: blood pressure (BP) 132/88 mmHg, heart rate (HR) 96, respi- ratory rate (RR) 14, and an oxygen saturation of 94% at room air. He was alert and oriented without acute distress. Heart sounds were regular, with no murmur, click, bruit, or rubs noted. Breath sounds were clear to auscultation bilaterally. His abdomen was sot, nontender, with no pulsatile mass, rebound, or guarding. he let lower extremity was pale and cold compared to the contralateral leg with strength at a one out of ive. he ED physician was unable to palpate or detect a Doppler signal in the let femoral, popliteal, posterior tibialis, and dorsalis pedis arteries. Strength was