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===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:<ref name="von KodolitschSchwartz2000">{{cite journal|last1=von Kodolitsch|first1=Yskert|last2=Schwartz|first2=Ann G.|last3=Nienaber|first3=Christoph A.|title=Clinical Prediction of Acute Aortic Dissection|journal=Archives of Internal Medicine|volume=160|issue=19|year=2000|pages=2977|issn=0003-9926|doi=10.1001/archinte.160.19.2977}}</ref><ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/clinical-featuresdissection -indication and-diagnosis-of-acute-aortic-dissection|title=Clinical features and diagnosis of acute aortic dissection|author=James H Black, III, Warren J Manning|website=UpToDate}} This topic last updated: Feb 16, 2018. Topic 8190 Version 29.0}}</ref>*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 radiographyProbability of dissection was found to be relatively low (7%) only in the absence of all 3 variables.<ref name="von KodolitschSchwartz2000"/> ===Choice choice of modality===*Hemodynamically stable patients without suspected ascending aortic involvement, '''[[CT angiography]]''' is generally the initial imaging method of choice.<ref name=UpToDate/> It should cover the entire aorta, even if symptoms are limited to the thorax (in order to see the extent in case a dissection is detected).*For hemodynamically '''un'''stable patients or where a dissection of the ascending aorta is suspected, '''[[transesophageal echocardiography]] (TEE)''' is suggested as the first investigation of choice.<ref name=UpToDate/> ==Evaluation==<gallery>File:DissectionCT.png|CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta, as a </gallery> ===Classification==={| border="1" cellspacing="0" style="width:320px;float:right;margin-left:0.5em;border-collapse:collapse"|+ '''Classification of aortic dissection'''|-|valign="top"|[[File:Aortic dissection of DeBakey type I.png|100px]]|valign="top"|[[File:Aortic dissection of DeBakey type II.png|90px]]|valign="top"|[[File:Aortic dissection of DeBakey type III.png|130px]]|- style="background:#dcdcdc;"|-| colspan=2 style="text-align:center;"|Stanford A (Proximal)| style="text-align:center;"|Stanford B (Distal)|-| style="text-align:center;" border="0"|DeBakey I| style="text-align:center;"|DeBakey II| style="text-align:center;"|DeBakey III|} The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.<ref name=Daily1970>{{cite journal |doi=10.1016/S0003-4975(10)65594-4 |vauthors=Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE |title=Management of acute aortic dissections |journal=Ann Thorac Surg. |volume=10 |issue=3 |pages=237–47 |date=Sep 1970 |pmid=5458238 }}</ref>*'''A''' – involves the ascending aorta and/or aortic arch, and possibly the descending aorta. The tear can originate in the ascending aorta, the aortic arch, or more rarely, in the descending aorta. *'''B''' – involves the descending aorta or the arch (distal to the left subclavian artery), without the involvement of the ascending aorta. The Stanford classification is more useful than the older DeBakey system as it follows clinical practice, as type A ascending aortic dissections generally require primary surgical treatment, whereas type B dissections can initially be treated conservatively.
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==Planning==
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