Detection of complex intimal flaps in aortic dissection by transesophageal echocardiography

Abstract

Transesophageal echocardiography (TEE) is of proven benefit for the diagnosis of aortic dissections. 1 TEE provides excellent imaging of the thoracic aorta, allowing for the detection of intimal flaps, determination of false and true lumina, and evaluation of other cardiac anatomic structures. 1 Although aortography has traditionally been considered the procedure of choice in defining the anatomy of aortic dissections, recent studies showed equal or superior sensitivity and specificity of TEE in defining these lesions. 1 Thus, TEE may prove to be the gold standard for the diagnosis of aortic dissections. To maintain a high degree of accuracy, varied and unusual forms of dissection must be recognized. Of 22 patients who underwent TEE for suspected or known aortic dissection, complex intimal flaps were detected in 3. In all cases, the morphology defined by biplane TEE was confirmed by surgery or magnetic resonance imaging. The 3 cases (Table I) comprised an intimo-intimal intussusception, a tripartite intimal spit and an unusual cylindrical thrombus adherent only to the false lumen side of the intimal flap.