Sensitivity and Specificity of Various ECHO Findings

Transthoracic Echo (TTE) for Aortic Dissection

Population / Technique	Sensitivity	Specificity
Any dissection (mixed Stanford A + B)	≈ 62 %	≈ 88 %
Ascending (Stanford A)	≈ 85 %	≈ 85 %
Descending (Stanford B)	≈ 46 %	≈ 87 %
Contrast-enhanced TTE (proximal)	up to 93 %	up to 97 %

Practical take-away: TTE is specific but not fully sensitive. A clear intimal flap is confirmatory; a negative TTE—especially for type B—must be followed with gated CT or TEE if suspicion remains high.

TTE for Detecting Vegetations (Infective Endocarditis)

Valve / Setting	Sensitivity	Specificity
Native valves	≈ 60–70 %	≈ 90–95 %
Prosthetic valves	≈ 30–55 %	≈ 85–90 %

Key points:

• TTE reliably rules-in IE when a mobile mass is seen, but a negative scan—especially with prosthetic valves—does not exclude the disease.
• Vegetation size and image quality dominate performance; consider harmonic imaging or early TEE when clinical suspicion is high.

TTE Sensitivity / Specificity for Intracardiac Thrombus

Chamber	Sensitivity	Specificity	Notes
Left Ventricle (LV)	≈ 55–60 %	≈ 95–99 %	Contrast boosts sensitivity to ~64 %
Left Atrium / LAA	≈ 40–60 %	≈ 90–94 %	Poor appendage visualisation; use TEE
Right Atrium (RA)	≈ 30 %	≈ 100 %	Few false-positives but many misses
Right Ventricle (RV)	≈ 40–50 %	> 90 %	Non-standard views improve yield

Clinical pearls: LV thrombus is the most detectable on TTE; atrial and right-sided clots are frequently missed. A positive TTE finding across chambers is highly specific and should trigger therapy or confirmatory imaging; a negative study rarely rules out LA/LAA or right-heart thrombus when management decisions hinge on exclusion.