78 years female presented to the ED with a dizzy spell. She felt unwell for the last 24hours. Denied any abdominal, chest or back pain. She had past medical history of hypertension and abdominal aortic aneurysm measuring 4.3cm, 4 months ago. Routine observations including pulse, Blood pressure and temperature were normal. She was found to have minimal abdominal tenderness. Ed bedside US showed:

A 4.9 cm AAA with dissection was seen with the ultrasound.

Spontaneous IAAD is a rare clinical condition. In the International Registry of Acute Aortic Dissection (IRAD), 1.3% of the enrolled patients were identified as having IAAD^1. The association with atherosclerosis or an iatrogenic etiology is stronger for acute IAAD. Abdominal aorta (IAAAD) has been considered an unusual event presenting with various clinical signs.1,2 They commonly present with faints, dizzy spells, back or abdominal pain. Earlier diagnosis is the key to good out come. Bedside US is easy and readily available and in trained hands doesn’t take more than 2 minutes to get the diagnosis.

1. Trimarchi S, Tsai T, Eagle KA, Isselbacher EM, Froehlich J, Cooper JV, Rampoldi V, Upchurch GR. Acute abdominal aortic dissection: insight from the International Registry of Acute Aortic Dissection (IRAD). J Vasc Surg 2007;46:913–
2. Farber A, Wagner WH, Cossman DV, Cohen JL, Walsh DB, Fillinger MF, et al. Isolated dissection of the abdominal aorta: clinical presentation and therapeutic options. J Vasc Surg 2002;36:205-10.