Role of echocardiography in the diagnosis of acute aortic syndrome.

Acute aortic syndrome (AAS) comprises a variety of pathologically distinct life-threatening conditions such as aortic dissection, intramural hematoma (IMH) of the aorta, penetrating aortic ulcer (PAU), traumatic transection as well as symptomatic aortic aneurysm. Patients presenting with AAS require immediate diagnosis in order to rapidly initiate adequate therapeutic measures. Echocardiography is a rapidly available imaging technique which detects AAS with high sensitivity and specificity. Compared to computed tomography (CT) and magnetic resonance imaging (MRI), echocardiography allows emergency examination of unstable patients at bedside or even directly in the operating room. Transthoracic echocardiography (TTE) may be used initially in the emergency setting to gain information about left ventricular function as well as the presence of aortic regurgitation and pericardial effusion, but has only limited diagnostic accuracy for diagnosing AAS. Transoesophageal echocardiography (TOE) is used to directly visualise the aortic pathology in both the ascending and descending aorta. This article reviews the role of echocardiography in the emergency assessment of patients presenting with acute aortic syndrome.