R loin pain

54 yo male with a hx of IVDU, seemingly drug affected presented to ED with R loin pain requesting morphine. He stated he had not passed urine for one day. 

HR 80, BP 176/90, sats 100, afebrile.

Bladder scan revealed 62ml in his bladder. 

Pain did not settle despite morphine. 

The ED reg had a look with bedside US at his aorta first

Abdominal aorta (long) - probe marker cranial (annotated below)

Abdominal aorta (long) - annotated

Abdominal aorta (trans) - annotated below

The registrar looked at both kidneys and bladder and there was no sign of obstruction. She also looked for evidence of type A dissection (dilated proximal aorta, pericardial effusion, aortic regurgitation) but found none. 

Urgent CT revealed a dissection flap from the coeliac trunk to the right iliac.

A dissection typically undulates. This one is a bit rigid. But in the trans view, it clearly undulates independent of aortic wall pulsations. 

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