Yigal had a 70yo patient who was sent in by the GP with central abdominal pain and a pulsatile mass in the epigastrium.
ED US was performed upon arrival and revealed:
transverse view of the aorta with a dissection flap undulating in its lumen
Longitudinal view of the aorta
A dissection flap is hyper echoic and undulates independent of aortic pulse. There may also be hypo echoic thrombus in the false lumen.Seeing a flap in the aorta is highly specific and sensitive for dissection. However, sometimes slice thickness artefact can lead to flap like lines in the aortic lumen. Just remember that a flap will be thick and seen in trans and long. An artefact will usually be thin, disappear in a different angle or view and can be linked to an adjacent structure like the IVC.