Answer 7

7.  Choice C is the correct answer.  This patient with his presenting symptoms and impaired renal function needs a TEE.  CT with IV contrast is contraindicated when the creatinine is greater than 2.0.  The above two are the only two options for screening for a dissection.  A normal ECHO is not going to be able give you any information rather the patient is dissecting or not.  Taking the patient to surgery without a definitive diagnosis is dangerous and should not be done.