Echocardiography in diagnosis of aortic dissection

In a multicentre study the accuracy of echocardiography was measured in 164 consecutive patients with suspected aortic dissection. The diagnosis was subsequently proven (82 patients) on the basis of transthoracic and transoesophageal echocardiography and additional diagnostic procedures, including computed tomography (CT), aortic angiography, and surgery and/or necropsy. The sensitivity and specificity of echocardiography were 99% and 98%, respectively, with positive and negative predictive values of 98% and 99%. For CT sensitivity was 83%, specificity 100%, and positive and negative predictive values 100% and 86%, respectively. For aortography sensitivity and specificity were 88% and 94%, and the positive and negative predictive values 96% and 84%, respectively. Echocardiography, including the transoesophageal route, can provide accurate diagnosis of aortic dissection within 15 min. Diagnostic difficulties occur only in a few type II dissections, when complementary diagnostic procedures, including CT or angiography, may be needed. To clarify branch involvement angiography is required.