The Assessment of Aortic Dissections

Don't Miss This Urgent Echo Finding

The Basics

The aorta consists of three layers — the inner layer (intima), the middle layer (media), and the outer layer (adventitia). When there is a weakening of the inner layer, a tear can occur and allows blood to pass between the intima and the media. This separation is referred to as a dissection and is a life-threatening condition that we evaluate with echocardiography. There are 5 video case examples included in this article for a comprehensive understanding on both TTE and TEE.

Role of Echocardiography

We visualize the aorta in multiple imaging windows: the parasternal long axis, parasternal short axis, apical, subcostal, suprasternal notch, and of course the right parasternal view. Off-axis imaging is recommended and tools like x-plane are encouraged to thoroughly investigate the intimal flap.

Echocardiograms can be performed at the patient’s bedside in urgent case scenarios. The aortic root, ascending aorta, aortic arch, descending thoracic aorta, and abdominal portion are assessed with varying sensitivity. It is our job as providers to recognize dilation of the aorta and investigate further. Pericardial effusions and significant aortic regurgitation are red flags when an aortic dissection is suspected.