Aortic dissection.

ACUTE ASCENDING AORTIC DISSECTION is a serious condition with significant mortality requiring prompt diagnosis and surgical treatment as mortality rates increase hourly without intervention. There are a number of modalities currently used to diagnose aortic dissection, including computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE), each with different strengths and weaknesses in regard to speed, accuracy, and ease of performance. There exists a balance between rapid diagnosis with comprehensive information regarding anatomic detail, vascular branch involvement, false lumen identification, and speed with which the diagnosis can be made to expedite potential surgical treatment. The optimal diagnostic mode for identifying ascending aortic dissection remains controversial. Additionally, the various methods of imaging used to evaluate for aortic dissection all carry potential disadvantages of artifact within the image, complicating the diagnostic process and at times leading to false-positive diagnoses. Managing this balance represents some of the difficulties in identification and treatment of these patients. The authors present a patient who was anesthetized for repair of a suspected ascending aortic dissection based on CT findings, yet subsequent TEE revealed normal anatomy.