Abstract 4371805: False-Positive Aortic Intimal Flap on Echocardiography in an Asymptomatic Adolescent: Clinical Correlation Prevents Misdiagnosis

Abstract

Background: Echocardiography is frequently used as a first-line imaging tool for aortic evaluation, but its susceptibility to artifacts can lead to false-positive findings. Aortic dissection is a critical diagnosis that requires confirmation with advanced imaging before initiating treatment. This case report highlights the clinical importance of clinical correlation and confirmatory imaging when echocardiographic findings suggest aortic dissection in the absence of symptoms. Case presentation: A 12-year-old male with a remote history of self-resolving dyspnea and previously noted trivial mitral regurgitation presented for routine follow-up. He was clinically well with no cardiac symptoms, normal vital signs, and an unremarkable physical exam. Echocardiography revealed an apparent intimal flap (Figure 1-3) in the proximal ascending aorta, raising concern for aortic dissection. There was no associated turbulent flow, pericardial effusion, or signs of hemodynamic compromise. Due to the gravity of potential dissection, a contrast-enhanced computed tomography (CT) aortogram was performed. CT imaging showed normal aortic anatomy with no evidence of dissection, intimal flap, aneurysm, or other structural abnormalities. Retrospective echocardiographic image review suggested the finding was likely an artifact, possibly due to reverberation or suboptimal transducer angulation. A repeat echocardiogram three months later showed a persistent but less prominent artifact. No intervention was required, and the patient remained asymptomatic. Conclusion: This case demonstrates that echocardiographic artifacts can mimic life-threatening conditions such as aortic dissection. CT aortography remains the gold standard in confirming aortic pathology, particularly in cases where echocardiographic findings are incongruent with the clinical presentation. Incorporating clinical judgment and confirmatory imaging prevents unnecessary anxiety, testing, and interventions, especially in pediatric patients.