Background: Several studies have demonstrated the feasibility of pre-hospital US in patients with trauma, cardiac arrest and respiratory insufficiency. It should be rapid, problem based and the use of specific protocols (FAST, FEEL, RUSH) prevents delays. Case presentation: We present a case of a 50 years old man with a syncope while he was working. When the ambulance arrived, he was hemodynamically unstable, referred dorsal lumbar pain, an asymmetry of the radial pulses was found, and the electrocardiography didn't register any ST segment alterations. A pre-hospital US showed a dilation of the ascendant aorta and a floating flap inside the aortic arch and the abdominal aorta. The CT scan confirmed a dissection from the aortic bulb to the left femoral artery and the patient was transported rapidly to the nearest heart and thoracic surgeries. Conclusion: The evaluation of the aorta should be considered a new indication of pre-hospital ultrasound.

Keywords: Point of care Ultrasound, pre-hospital, abdominal aorta, dissection