The patient presented with vague chest pain. A chest xray revealed a widened mediastinum.
There is a pericardial effusion with a mobile echogenic mass seen to move on the surface of the right ventricle, consistent with a thrombus. The aortic root is dilated.
Although a dissection flap could not be seen on the bedside echo, the combination of chest pain, haemorrhagic pericardial effusion and dilated aortic root is virtually diagnostic of aortic dissection.