753-3 Transesophageal Echocardiographic Findings of Non-traumatic Thoracic Aortic Rupture with or without Associated Dissection

Thoracic aortic rupture in the absence of trauma is a rare but life-threatening condition which requires prompt and accurate diagnosis. Transesophageal echocardiography (TEE) has become the diagnostic tool of choice in aortic dissection, but its role in the detection of aortic rupture has not been well defined. To assess the TEE features of non-traumatic aortic rupture we reviewed 3800 consecutive TEE studies to identify patients diagnosed by TEE to have aortic rupture and with convincing clinical findings such as early deaths or surgical confirmation. Ten patients were identified (5 men and 5 women, age 70.3±5.9 years). All presented with chest pain, and 7 had hypotension. One patient ruptured into the pericardium and 9 into the mediastinum. Associated aortic dissection (3 type A and 3 type B) was present in 6. Urgent surgery was performed in 5, 2 of whom survived. All 5 non-surgical patients died, and autopsy was performed in 3 with confirmation of the diagnosis. TEE findings were as follows: indistinct aortic wall in 10, extrinsic periaortic mass in 10, dilated descending aorta in 10, aortic aneurysm in 6, and dissection flap in 6. The rupture site was thrombosed in 7, while in the remaining 3 patients free flowing blood into the mediastinum was detected.ConclusionNon-traumatic aortic rupture can occur with or without dissection. The findings on TEE of an indistinct aortic wall and periaortic hematoma in an enlarged aorta strongly suggest rupture. Early diagnosis by TEE leading to corrective surgery may result in a more favourable outcome