In recent years, 2D echocardiography has dramatically changed the diagnostic approach to aortic dissection. TTE is a convenient screening test (Fig. 13-67) and often enables accurate detection of ascending aortic dissection.253 The diagnostic findings include a dilated aorta with a mobile intimal flap that presents as a thin, linear signal within the lumen. Transthoracic imaging is unreliable for detection of descending aortic dissection,254 although it occasionally visualizes the complete length of the thoracic aorta (see also Chap. 88).
Although several noninvasive methods exist to diagnose aortic dissection, TEE has become the procedure of choice in many hospitals because of its accuracy, portability, rapid procedural time, and ability to provide data regarding valvular regurgitation and LV function.139,158,255-257 Except for a short portion of the proximal aortic arch, which is obscured by the bronchus, multiplane TEE provides excellent visualization of the entire thoracic aorta and high accuracy in detecting aortic enlargement, intimai tears, and false lumen thrombus (B+-0- Fig. 13-68). CFD may reveal communications between true and false channels Fig. 13-51, Plate 59; Fig. 13-69,
Plate 61). TEE also appears useful for the diagnosis of aortic intramural hematoma, an increasingly recognized disorder which has a clinical prognosis similar to that of classic dissection.258,259
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