Acute ascending aortic dissection diagnosed with transthoracic echocardiography.

A 79-year-old man with a known ascending aortic aneurysm presented to his physician's office with an episode of severe "tearing" type chest pain after lifting several boxes. Physical examination was notable for low blood pressure and a new diastolic murmur. The patient was transferred to intensive care, and a transthoracic echocardiogram was performed. This demonstrated a dissection flap clearly seen superior to the sinuses of Valsalva and severe aortic insufficiency. Computed tomography or transesophageal echocardiography is typically the initial test of choice, but transthoracic echocardiography can rapidly confirm the diagnosis of acute ascending aortic dissection.