Aortic dissection

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Author: Mikael Häggström [notes 1]

Planning

Need of investigation

According to a clinical prediction rule of the American Medical Association, symptoms that best determine the risk of acute aortic dissection in patients with acute chest pain, acute back pain, or both are:[1][2]

  • Pain in the chest or abdomen with immediate onset and a tearing or ripping character
  • Differentials in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20 mmHg difference between the right and left arm)
  • Mediastinal and/or aortic widening on chest radiography

Probability of dissection was found to be relatively low (7%) only in the absence of all 3 variables.[1]

Choice of modality

  • Hemodynamically stable patients without suspected ascending aortic involvement, CT of aortic dissection is generally the initial imaging method of choice.[2]
  • For hemodynamically unstable patients or where a dissection of the ascending aorta is suspected, transesophageal echocardiography (TEE) is suggested as the first investigation of choice.[2]

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. 1.0 1.1 von Kodolitsch, Yskert; Schwartz, Ann G.; Nienaber, Christoph A. (2000). "Clinical Prediction of Acute Aortic Dissection ". Archives of Internal Medicine 160 (19): 2977. doi:10.1001/archinte.160.19.2977. ISSN 0003-9926. 
  2. 2.0 2.1 2.2 James H Black, III, Warren J Manning. Clinical features and diagnosis of acute aortic dissection. UpToDate. This topic last updated: Feb 16, 2018. Topic 8190 Version 29.0}}