Atypical Aortic Dissection Diagnosed by Transesophageal Echocardiography

This case report describes a patient in whom a thin dissection of the proximal aorta was diagnosed by transesophageal echocardiography. Dissection was not firmly diagnosed in our patient with computed tomography, angiography, or magnetic resonance imaging. A definitive diagnosis was made prospectively using intraoperative transesophageal echocardiography by demonstrating the presence of a thin immobile dissection flap located very close to the anterior aortic wall. Color Doppler examination showed absence of flow signals in the small false lumen, suggesting that it may be clotted. At surgery the presence of dissection involving the ascending aorta, as well as a clotted false lumen were confirmed. This finding demonstrates the utility of transeophageal echocardiography in the diagnosis of aortic dissection and the ability of this test to differentiate a thin dissection from intimal thickening. (ECHOCARDIOGRAPHY, Volume 11, May 1994)