The paravertebral panto: it's behind you!

This case report highlights the utility of paravertebral (PV) imaging in the diagnosis of aortic dissection, the evaluation of left ventricular systolic function and drawing the distinction between pleural and pericardial effusions. In this case, less attenuation of the ultrasound beam, reduced lung viscosity due to pleural effusions and less impedance mismatch between media led to images of superior quality and high diagnostic value. This supports the use of paravertebral imaging as an adjunct to conventional echocardiography windows, particularly when conventional transthoracic imaging proves challenging. LEARNING POINTS: PV images provide superior resolution when interrogating the descending aorta and thus can reveal incidental findings such as aortic dissection. PV imaging provides clearer delineation between pericardial and pleural effusions. Additional information may be obtained from the PV window in relation to left ventricular systolic function particularly in the setting of suboptimal transthoracic image quality.