Aortic dissection echocardiography or ultrasound

Associate Editor-In-Chief:

Echocardiography
The transesophageal echocardiogram (TEE) is a relatively good test in the diagnosis of aortic dissection, with a sensitivity of up to 98% and a specificity of up to 97%. It is a relatively non-invasive test, requiring the individual to swallow the echocardiography probe. It is especially good in the evaluation of AI in the setting of ascending aortic dissection, and to determine whether the ostia (origins) of the coronary arteries are involved. While many institutions give sedation during transesophageal echocardiography for added patient-comfort, it can be performed in cooperative individuals without the use of sedation. Disadvantages of the TEE include the inability to visualize the distal ascending aorta (the beginning of the aortic arch), and the descending abdominal aorta that lies bellow the stomach. A TEE may be technically difficult to perform in individuals with esophageal strictures or varices.

Transthoracic (TTE) unfortunately does not provide pretty pictures of the distal ascending, transverse and descending aorta in a small number of patients. Its use is limited to assess cardiac complications of dissection including AI, tamponade and LV function.

Transesophageal (TEE), however, is a portable technique that can be brought to the emergency department and establish a diagnosis in < 5 minutes of starting the test. It can identify true and false lumens, the intimal flap, thrombosis in the false lumen, pericardial effusion, AI, and the proximal coronaries. Although monoplane TEE has a sensitivity of 98%, its specificity is only 77%. This can be increased to a sensitivity and specificity of 99% and 98% respectively with combined use of TTE and TEE. Biplane and multiplane imagine however have been shown to be 98% sensitive and 95% specific for aortic dissection.

In general, it is recommended to perform bedside multiplane TEE in patients with acute symptoms or clinically unstable, and MRI in patients with a more chronic presentation if they are hemodynamically stable.

CT angio is reserved for patients whom TEE or MRI is unavailable or contraindicated. Aortography is required if the tests listed above are non-diagnostic.







Aortic Dissection Type A Example 1

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Aortic Dissection Type A Example 2

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Aortic Dissection Type A Example 3

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Aortic Dissection Type A Example 4

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Aortic Dissection Type A Example 5

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Aortic Dissection Type A Example 6

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Aortic Dissection Type B Example 1

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Aortic Dissection Type B Example 2

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Acknowledgements
The content on this page was first contributed by: David Feller-Kopman, MD and C. Michael Gibson M.S., M.D.