To discuss the echocardiographic differential diagnosis of aortic dissection with severe aortic regurgitation and aortic valve prolapse.

The echocardiographic features of one case who was suspected as aortic valve insufficiency first and was confirmed as aortic dissection at last by echocardiography and computed tomography angiography (CTA) analyzed retrospectively.

A patient who was diagnosed as aortic valve insufficiency was analyzed.Severe aortic regurgitation and a prolapse flap could be found at left ventricular outflow tract in diastole, and the initial impression of this patient was aortic valve prolapse.Then the further imaging revealed that the flap structure originated from the aortic root and extended upward, and shifted into the left ventricular outflow tract with blood flow.So the patient was diagnosed as aortic dissection with severe aortic regurgitation finally, and was confirmed by followed CTA as well as surgery.

The structure of aortic root should be observed carefully when severe aortic regurgitation and aortic valve prolapse are found in echocardiography examination.To avoid misdiagnosis, it should be pay more attention to dissection when ascending aortic dilates.