What does this research mean for the field?

Transesophageal echocardiography is crucial for diagnosing atypical, painless type A aortic dissection presenting as acute heart failure when non-ECG-gated computed tomography angiography fails to detect the condition. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe an atypical presentation of painless Stanford type A aortic dissection presenting as acute pulmonary edema and evaluate the role of transesophageal echocardiography when computed tomography angiography is inconclusive.

September 15, 2026European Heart Journal Supplements

A Wolf in Sheep’s Clothing: Painless Type a Aortic Dissection With Initially Negative Ct Angiography and the Pivotal Role of Transesophageal Echocardiography

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Type A aortic dissection (n=1). Intervention: Transesophageal echocardiography (TEE) vs. Computed tomography angiography (CTA). Primary outcome: Diagnosis of type A aortic dissection.

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Key result

TEE diagnoses painless type A aortic dissection presenting as acute heart failure after CT fails.

Why the study?

Painless type A aortic dissections can evade diagnosis, particularly when non-ECG-gated CTA is performed for non-aortic indications.

Population

A 52-year-old hypertensive, obese man presenting with acute dyspnoea and pulmonary oedema without chest pain

Design

Case report

Authors

PCP Caretto IBI Barnaba RRR Romito

Discussion

Member takes

Implication

Supports TEE when suspicion for type A dissection persists despite negative non-gated CTA; leaves open prospective validation in atypical presentations.

Key Points

To describe an atypical presentation of painless Stanford type A aortic dissection presenting as acute pulmonary edema and evaluate the role of transesophageal echocardiography when computed tomography angiography is inconclusive.
Clinical and diagnostic workup of a 52-year-old hypertensive, obese male presenting with acute dyspnea, pulmonary edema, and elevated D-dimer in the absence of chest pain.
Diagnostic evaluations included standard non-ECG-gated thoracic computed tomography angiography (CTA), transthoracic echocardiography, transesophageal echocardiography (TEE), and a repeat urgent aortic CTA.
Both the initial non-ECG-gated thoracic CTA and a repeat urgent aortic CTA failed to demonstrate definitive evidence of aortic dissection.
TEE identified an intimal flap originating at the aortic root and extending toward the left coronary ostium, along with acute severe eccentric aortic regurgitation.
Emergency surgery confirmed an acute type A dissection with a circumferential intimal tear along the sinotubular junction, successfully treated via a Bentall procedure.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 52-year-old hypertensive, obese man presenting with painless type A aortic dissection and acute heart failure.

Exposure

Transesophageal echocardiography (TEE) and subsequent emergency Bentall procedure

Comparator

Non-ECG-gated computed tomography angiography (CTA)

Outcome

Diagnosis of type A aortic dissection

TEE is crucial for diagnosing atypical, painless type A aortic dissection presenting as acute heart failure when non-ECG-gated CTA is negative.

Limitations

Non-ECG-gated CTA performed for non-aortic indications may miss painless type A aortic dissection.

Cite This Study

Caretto et al. (2026) conducted a case report in Type A aortic dissection (n=1). Transesophageal echocardiography (TEE) vs. Computed tomography angiography (CTA) was evaluated on Diagnosis of type A aortic dissection. Transesophageal echocardiography successfully diagnosed an atypical painless type A aortic dissection presenting as acute heart failure after non-ECG-gated CT angiography failed to show the dissection.

synapsesocial.com/papers/6aa90187eed42882c1fc19fd https://doi.org/10.1093/eurheartjsupp/suag058.308

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Implication

Supports TEE when suspicion for type A dissection persists despite negative non-gated CTA; leaves open prospective validation in atypical presentations.

A Wolf in Sheep’s Clothing: Painless Type a Aortic Dissection With Initially Negative Ct Angiography and the Pivotal Role of Transesophageal Echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

A Wolf in Sheep’s Clothing: Painless Type a Aortic Dissection With Initially Negative Ct Angiography and the Pivotal Role of Transesophageal Echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider