Differential Transesophageal Echocardiographic Diagnosis Between Linear Artifacts and Intraluminal Flap of Aortic Dissection or Disruption
Spontaneous acute aortic dissection (AD) and traumatic disruption of the thoracic aorta (TDA) are life-threatening conditions that require rapid and accurate diagnosis. Transesophageal echocardiography (TEE) has been proposed as a first-line imaging technique for the evaluation of patients with suspected AD’2 and for the screening of victims sustaining blunt chest trauma who are at high risk for TDA. However, the diagnostic accuracy of TEE in both of these entities has been limited by relatively low specificity, predominantly because of the presence of intraluminal linear artifacts. mycanadianpharmacy.com
Multiple-path artifacts are the result of reverberations between strongly reflective surfaces. Multiple reflections occur when the ultrasound beam strikes an interface with large impedance mismatch between media (eg, soft tissue or fluid-gas), particularly if the interface is oriented perpendicular to the direction of sound propagation. Reverberations between the interface and the esophageal transducer may occur, resulting in linear artifacts that do not-correspond to anatomic structures. When located within the thoracic aorta, linear artifacts may be misinterpreted as intraluminal flaps and lead to false-positive diagnoses’ and needless thora-cotomy.
Linear artifacts within the ascending aorta are commonly encountered in patients with suspected AD. Little information is currently available on the TEE diagnostic criteria required to distinguish linear artifacts from true aortic flaps. In addition, to our knowledge, the incidence of these artifacts within the descending thoracic aorta and their potential impact on TEE diagnostic accuracy have not yet been studied. Accordingly, the aims of the present study were (1) to determine the incidence of intravascular linear artifacts within the ascending and descending thoracic aorta in a large cohort of patients undergoing a TEE study for a suspected acute aortic condition; (2) to establish the differential TEE diagnostic criteria that distinguish intra-aortic linear artifacts from true flaps associated with AD or TDA; and (3) to prospectively evaluate the impact of these criteria on the TEE diagnostic accuracy of aortic flaps.