Ultrasound for suspected thoracic dissection is an excellent tool to decrease time to diagnosis and treatment for this high mortality diagnosis. When scanning for suspected thoracic dissection, combine a parasternal long view with an abdominal aorta view for maximum sensitivity. Start with the parasternal view to look for dilation of the aortic root > 4 cm or a visible dissection flap. You should also look for a flap in the descending thoracic aorta (found just deep to the left atrium). A quick peek at the abdominal aorta can also give you valuable information. If there is visible dissection flap in the setting of chest pain, this suggests there’s also a thoracic dissection. If you have a positive scan for dissection that has fluid around the heart, this is extra bad and resources should be mobilized ASAP. Just like any test, you have to know its limitations. With sensitivities ranging from 77-96% it’s not a sufficient rule out test for dissection. Think of ultrasound as a rule in test that will save time to diagnosis and treatment for this life threatening condition, so pick up the probe the next time you think thoracic aortic dissection.