Aortic dissection – there is an echogenic flap with in the lumen. It does not have the appearance of an artefact

Initial management of distal dissection is control of blood pressure with analgesia, B blockers and other anti-hypertensives. CT should be performed to confirm the diagnosis and the extent of the dissection as if the ascending aorta is involved (type A) then cardiothoracic repair may be required.