Echo Findings In Aortic Dissection

A few echo findings in aortic dissection

1. Dissection flap

This is a classic feature, but may not be clearly seen on transthoracic echo. Typically the flap movement is independent and bears no resemblance to the movement of the aortic wall on M-mode. The absence of this flap does not rule out aortic dissection, and further evaluation with either a TOE, CT or cardiac MRI is required.

Here is a transesophageal echocardiography image of an aortic dissection affecting the proximal aorta.

2. Pericardial effusion 

In dissections that involve the aortic root, it can extend back into the pericardial space causing a tamponade. This is life-threatening and requires immediate treatment. The presence of blood in the pericardial space alone can be sufficient to make a diagnosis of a dissection, even in the absence of a flap.

3. Reverberation artifact

Imaging of the aorta with TTE is difficult, and occasionally reverberation artifacts may be seen that could be misdiagnosed as a dissection flap. Reverberation artifacts typically move in line with the aortic walls on M-mode.

Most cases of aortic dissection require immediate management and surgery. Transthoracic echo is recommended as a diagnostic tool in acute dissection in the emergency room.

References

1. Meredith EL, Masani ND. Echocardiography in the emergency assessment of acute aortic syndromes. Eur J Echocardiogr 2009;10:131-9