Diagnosis of aortic dissection: The value and limitations of transesophageal echocardiography

Paczek, Anna; Rydlewska-Sadowska, W

doi:10.1055/s-0031-1275967

Cited by 1 publication

(1 citation statement)

References 18 publications

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“… 20 Our review of the literature additionally yielded a number of cases in which AAD was diagnosed using echocardiography and subsequently ruled out by CT 21 – 24 aortography, 21 , 22 , 25 MRI, 22 or direct visualization at surgery. 25 – 28 …”

Section: Discussionmentioning

confidence: 99%

A low threshold to ECG-gated repeat CTA reduces the risk of false-positive diagnosis of type A dissection in interhospital referrals: a case series study

Kornberger¹,

Burck²,

Beyrouti³

et al. 2018

TCRM

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BackgroundFalse-positive diagnosis of acute Stanford type A aortic dissection (AAD) on computed tomography angiography (CTA) is still an issue and may lead to substantial consequences. Given that electrocardiography (ECG)-gated CTA provides greater diagnostic safety, it may be assumed that interhospital referrals with a diagnosis of AAD based on non-ECG-gated pre-referral CTA carry an elevated risk of false-positive diagnosis.Patients and methodsWe reviewed a series of patients in whom a diagnosis of AAD based on non-ECG-gated pre-referral CTA was subsequently proven false by ECG-gated CTA. The artifacts that gave rise to the misdiagnosis, as well as the diagnostic pathways followed and the consequences of false-positive diagnosis were investigated.ResultsIn 5 patients, ECG-gated repeat CTA revealed artifacts in the pre-referral scans that had led to false-positive diagnosis and referral for emergent surgery. In the first case, the patient proceeded to surgery. In 4 subsequent cases, ECG-gated CTA was ordered because a false-positive diagnosis was suspected. We found that ECG-gated CTA rather than echocardiography provided sufficient information to rule out AAD in each of these cases. Comparison between pre-referral non-ECG-gated scans and ECG-gated repeat CTA demonstrated the wide range of artifacts that may give rise to a diagnosis of AAD.ConclusionPatient condition permitting, the threshold to ECG-gated repeat CTA should be low when doubt arises with regard to a diagnosis of AAD based on non-ECG-gated CTA in interhospital referrals.

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