[One- and two-dimensional echography for aneurysms and dissections of the aorta (author's transl)]

Aneurysms and dissections of the aorta--depending on their location--are the cause for a variety of cardiovascular symptoms. In most cases they are the result of a generalised disease of the vessel wall. Consequently, echographic examinations should include the entire aorta from the root to the bifurcation, systematically utilising all accessibilities. This procedure often permits a complete evaluation of the aorta and its major branches thus enabling more selective use of catheterization. Morphologic and topographic information is gained mainly from two-dimensional images, whereas functional behaviour such as wall pulsation can best be analyzed from the T-M echogram. Today echography is the method of choice in the diagnosis of aneurysms and follow-up studies. Even if thrombosis is present aneurysms can be extensively assessed. If branches of the aorta are involved--especially in the thoracic region--the echographic examination must be complemented by aortography prior to surgery. In acute dissection of the aorta, echography permits an early bedside diagnosis and recognition of life-threatening complications, e.g. acute aortic regurgitation and pericardial tamponade. T-M echography has mainly been used in the analysis of aortic root dissections and dissections of the ascending artery. Here the classical phenomenon of a duplicated wall-echo together with an enlarged vessel diameter is sensitive, yet little specific, since many other diseases in the region of the aortic root and the ascending artery demonstrate similar findings. In our group of 14 patients with extensive dissections, the observation of a floating or pulsating intima flap was more specific. By systematically screening the entire aorta we could follow the dissection from the ascending aorta to the descending region and, by means of the modern sector-scanning technique, even as far as into the main branches of the aorta. The information obtained in this manner provides a rational basis for therapeutic measures in this life-threatening disease.