What Echocardiographic Findings Suggest Acute Type A Aortic Dissection?

BACKGROUND: An acute Stanford Type A aortic dissection (ATAAD) carries a high in-hospital mortality rate that increases with delays to surgical intervention. Early diagnosis is therefore critical for improving outcomes. Unfortunately, ATAAD is often misdiagnosed initially. Moreover, definitive diagnosis with computed tomography angiography (CTA) requires time to obtain and may not be feasible in an unstable patient. Fortunately, emergency physicians can use transthoracic cardiac point-of-care ultrasound (POCUS) to make a quicker diagnosis, prompt earlier CTA, initiate goal-directed therapy, and reduce time-to-operative intervention. OBJECTIVE: This narrative review reports four echocardiographic findings that suggest the presence of ATAAD. For each finding, we describe the associated pathophysiology and summarize the literature evaluating diagnostic utility. We also use high-quality media to provide step-by-step tutorials and advanced pearls and pitfalls for translation to the bedside. DISCUSSION: The echocardiographic findings that suggest ATAAD are: aortic intimal flap, aortic root enlargement, aortic regurgitation, and pericardial effusion. CONCLUSION: The use of cardiac POCUS can rule in or strongly suggest the diagnosis of ATAAD. Although cardiac POCUS on its own should not be used to rule out ATAAD, the lack of any suggestive echocardiographic findings may lower suspicion for this diagnosis.