Longitudinal view aortic rupture on TEE

The TEE longitudinal view demonstrates a traumatic subadventitial rupture of the aortic isthmus. The thick medial flap (arrows) is almost perpendicular to the aortic wall because the injury was confined to a few centimeters. There is a large associated hemomediastinum as evidenced by the increased distance between the transesophageal probe in the esophagus and the posterior aortic wall (double arrow), and by the presence of an ultrasound signal consistent with blood between the anterior wall of the aortic isthmus and the left visceral pleura (double dashed arrow).