Assessment of Aortic Dissection and Hematoma

Abstract

Aortic dissection and aortic intramural hematoma are highly lethal diseases occurring mostly in patients with arterial hypertension or Marfan syndrome. Transesophageal echocardiography (TEE) is the diagnostic imaging procedure of choice in the unstable patient. Hallmarks of dissection are the presence of an intimal membrane, or flap, dividing a true and a false lumen, entry and reentry tears, periaortic hematoma, pericardial effusion or tamponade, and aortic regurgitation in dissection of the ascending aorta. TEE allows detection of involvement of the ascending aorta, which places the patient in an extremely high-risk group and necessitates urgent operation. The accuracy of TEE is similar to computed tomography and magnetic resonance imaging, with the added benefit of being feasible at the bedside or in the operating room. Precautions have to be taken during TEE to avoid an abrupt rise in blood pressure. Aortic intramural hematoma is often a precursor of classic dissection or accompanies it and can also be diagnosed by TEE, although the diagnosis is frequently difficult.

Get full access to this article

View all access options for this article.

References

Erbel R , Alfonso F , Boileau C , et al: Diagnosis and management of aortic dissection. Recommendations of the Task Force on Aortic Dissection, European Society of Cardiology. Eur Heart J 22:1642-1681, 2001.

Flachskampf FA , Daniel WG : Aortic dissection. Cardiol Clin 18:807-817, 2000.

Flachskampf FA : Aortic dissection. In Neskovic AN , Flachskampf FA , Picard MH , editors: Emergency Echocardiography. London: Taylor & Francis; 2005.

Erbel R , Engberding G , Daniel W , et al, and the European Cooperative Study Group for Echocardiography: Echocardiography in diagnosis of aortic dissection. Lancet 1:457-461, 1989.

Nienaber CA , von Kodolitsch Y , Nicolas V , et al: The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 328:1-9, 1993.

Bansal RC , Chandrasekaran K , Ayala K , et al: Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol 25:1393-1401, 1995.

Keren A , Kim CB , Hu BS , et al: Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol 28:627-636, 1996.

Movsowitz HD , Levine RA , Hilgenberg AD , et al: Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol 36:884-890, 2000.

Flachskampf FA , Decoodt P , Fraser AG , et al: Recommendations for performing transesophageal echocardiography. Eur J Echocardiogr 2:8-21, 2001.

10.

Mohr-Kahaly S , Erbel R , Kearney P , et al: Aortic intramural hemorrhage visualized by transesophageal echocardiography: Findings and prognostic implications. J Am Coll Cardiol 23:658-664, 1994.

11.

Nienaber CA , von Kodolitsch Y , Petersen B , et al: Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation 92:1465-1472, 1995.

12.

Harris KM , Braverman AC , Gutierrez FR , et al: Transesophageal echocardiographic and clinical features of aortic intramural hematoma. J Thorac Cardiovasc Surg 114:619-626, 1997.

13.

Flachskampf FA , Banbury M , Smedira N , et al: TEE diagnosis of intramural hematoma of the ascending aorta: A word of caution. J Am Soc Echocardiogr 12:866-870, 1999.