False-positive Transesophageal Echocardiography after False-positive Computed Tomography Angiography in Suspected Type A Aortic Dissection

ACCURATE and timely diagnosis is paramount in surgical decision-making in type A aortic dissection. Two independent imaging modalities are recommended; computed tomography angiography is the preferred first imaging modality (73% of cases), and intraoperative, preincisional transesophageal echocardiography is typically the second.1 Although highly sensitive and specific, both modalities contain spectra of false-negative and false-positive misinterpretations.2,3 The presented images were obtained from a patient with strong risk factors for aortic dissection: chest pain after an episode of cocaine abuse. Axial computed tomography angiography suggested an intimal flap in the ascending aorta (AA) adjacent to the pulmonary artery (PA;upper left panel,arrow). Initial intraoperative, preincisional transesophageal echocardiography seemed to collaborate the computed tomography angiography (upper middle andright panels, mid- esophageal short-axis and mid-esophageal long-axis views,arrows). However, slight adjustments to the imaging planes revealed the false-positive nature of these findings (lower panels). In the mid-esophageal short-axis view, the right coronary cusp was mistaken for a flap because, orthogonal to the ultrasound beam, it caused a stronger reflection than the slanted noncoronary and left cusps. The beam-width artifact in the far field of the mid-esophageal long-axis view resulted from the deterioration of lateral and elevational resolutions of the ultrasound beam as it w...

Source: Anesthesiology - October 16, 2018 Category: Anesthesiology Source Type: research