Document Detail


Echocardiographic findings mimicking type A aortic dissection.
MedLine Citation:
PMID:  16738839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Type A aortic dissection is a rare, but life-threatening disease. The prognosis is determined by an accurate and immediate diagnosis. CASE STUDY: A patient with suspected type A dissection based on outward transesophageal echocardiography (TEE) findings is reported. Renewed TEE showed dilation of the ascending aorta with pronounced wall thickness. A membrane-like structure was found in the ascending aorta. M-mode technique revealed movement of the suspected membrane that was partially in parallel to the aortic wall. Thus, there were severe doubts on the presence of type A dissection. By contrast, typical intimal rupture was found in the descending aorta. Computed tomography (CT) and angiography showed aortic dilation and an extended wall hematoma deriving from the entry at the descending part. There was no evidence of type A dissection. CONCLUSION: TEE is a noninvasive diagnostic tool to assess aortic dissection of type A with a sensitivity of 90-98% that is equal to CT or magnetic resonance imaging (MRI) solely. Complementary use of CT or MRI could improve the diagnostic accuracy. False-positive findings could result from echocardiographic artifacts concealing an intimal flap in the ascending aorta. Echo reverberations in dilated or calcified aortas had been judged to account for this phenomenon. In the present case, it could be assumed that the extended wall hematoma in accordance with vessel dilation mimicked the membrane-like structure. Oscillation or flutter of the suspicious intimal flap independently of aortal wall movement seem to be mandatory to avoid false-positive diagnoses. Ancillary findings such as flow signals, intimal fenestration or thrombosis are helpful to enhance the diagnostic specificity of TEE.
Authors:
Peter Alter; Matthias Herzum; Bernhard Maisch
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Herz     Volume:  31     ISSN:  0340-9937     ISO Abbreviation:  Herz     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-06-01     Completed Date:  2006-06-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7801231     Medline TA:  Herz     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  153-5     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine-Cardiology, Philipps University of Marburg/Lahn, Baldingerstrasse, 35033 Marburg, Germany. alter@mailer.uni-marburg.de
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Dissecting / ultrasonography*
Angiography
Aorta
Aortic Aneurysm, Thoracic / radiography,  surgery,  ultrasonography*
Aortic Rupture / radiography,  surgery,  ultrasonography*
Artifacts
Blood Vessel Prosthesis Implantation
Diagnosis, Differential
Dissection
Echocardiography, Transesophageal*
False Positive Reactions
Female
Humans
Middle Aged
Sensitivity and Specificity
Stents
Tomography, X-Ray Computed
Transplantation
Transplants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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