Figure 1.

Widened mediastinum on CXR. In the appropriate clinical context, a widened mediastinum (more than 8 cm at the level of the aortic knob) on CXR strongly suggests the need for additional aortic imaging. However, 40% of CXR in acute aortic dissection lack a widened mediastinum, and as many as 12%-37% are normal.[15,16] Other CXR findings suggestive of AD include pleural effusion, cardiomegaly, aortic contour abnormalities, inwards displacement of aortic wall calcification >10 mm, displacement of the trachea, mainstem bronchi, or esophagus (nasogastric tube), or aortic intimal calcification.[16]

Figure 2.

Tamponade on bedside TTE. Emergent ED transthoracic cardiac echo (subxyphoid view) visualized a pericardial effusion (>) and RV collapse (*) during diastole.

Figure 3.

Aortic regurgitation confirmed by formal TTE. Formal transthoracic echo (parasternal long view) visualizing moderate eccentric aortic regurgitation. The aortic outflow tract (>) is shown to have bidirectional flow with color Doppler.

Figure 4.

Dissection flap on TEE. Dissection flap (<) and false lumen (*) of the aortic root seen on transesophageal echo in cath lab. The aorta (A) and aortic valve (AV) are also shown.

Figure 5.

Severe aortic regurgitation on TEE. The transesophageal echo also demonstrated severe aortic regurgitation.