Abstract
Acute aortic dissection (AAD) is the prevalent acute aortic syndrome characterized by rapid onset and progression with time-dependent prognosis. When suspecting AAD of descending thoracic aorta in the context of the emergency department setting, computed tomography scanning and trans-esophageal echocardiography are the most useful imaging modalities. The sensitivity of transthoracic echocardiography in diagnosing for type B dissection is only 31%-55% when compared with other modalities. We describe the case of a 62-year-old female with a clinical history of Marfan syndrome where the low sensitivity of the transthorac approach in the detection of descending aortic dissection was overcomed by the posterior thoracic approach with the posterior paraspinal window (PPW). In the literature, are described just few reports where echocardiography via the PPW makes it possible to diagnose acute descending aortic syndrome.