Type B Aortic Dissection

 

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This subcostal TEE view shows at first subtle abnormality. A structure is seen within the abdominal aorta, that moves with each heart beat, consistent with a dissection flap.

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Use of color Doppler confirms the presence of an aortic dissection with pulsatile flow only within one lumen. Note that the true lumen involves the celiac artery. Flow can be seen entering this branch vessel.
Dissections can be missed if not sought after carefully.  Use of color Doppler along the abnormal aorta is important for this purpose.