Transesophageal echocardiography for ascending aortic dissection: Is it enough for surgical intervention?

Background: Acute ascending aortic dissection is a surgical emergency that requires expeditious diagnosis and prompt surgical intervention. In many ce nters, transesophageal echocardiography (TEE) is the test of choice on whic h surgical decisions are based. Echocardiographic False-positive diagnoses are rare but can occur with potentially severe consequences. Case report: T wo clinical cases where ascending aortic dissections were falsely diagnosed by TEE are presented. Discussion: Recent literature comparing the diagnost ic accuracy of TEE and other imaging techniques are reviewed. Anatomical li mitations of TEE and potential causes of false-positive results are discuss ed. Multiplane probe reduces, but does not eliminate, the occurrence of fal se-positive findings. To improve diagnostic specificity without undue delay s in the course of clinical decision making, we recommend dividing positive IEE findings into "definite" and "probable" categories. Such subclassifica tion is helpful in identifying cases where additional confirmatory tests ar e desirable in situations of uncertain diagnosis.