Aortic dissection - Revision history

Mikael Häggström: Less spacing

2018-11-15T14:48:27Z

Less spacing

Mikael Häggström: Forked

2018-11-15T14:48:07Z

Forked

Mikael Häggström: /* Classification */ more detailed

2018-11-15T14:44:29Z

Classification: more detailed

Mikael Häggström: /* Classification */ cleanup

2018-11-15T14:28:43Z

Classification: cleanup

Mikael Häggström: Coverage

2018-11-15T14:27:33Z

Coverage

Mikael Häggström at 15:47, 6 November 2018

2018-11-06T15:47:57Z

Mikael Häggström at 08:47, 26 September 2018

2018-09-26T08:47:57Z

Mikael Häggström: Mikael Häggström moved page CT of acute aortic dissection to Aortic dissection: Generalized

2018-09-03T12:27:54Z

Mikael Häggström moved page CT of acute aortic dissection to Aortic dissection: Generalized

Mikael Häggström: partly from material I previously added to Wikipedia article

2018-09-03T12:24:25Z

partly from material I previously added to Wikipedia article

New page

{{Authors
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
}}

==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:<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-features-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 radiography
Probability of dissection was found to be relatively low (7%) only in the absence of all 3 variables.<ref name="von KodolitschSchwartz2000"/>

===Choice of investigation===
*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/>
*Hemodynamically stable patients without suspected ascending aortic involvement, '''[[CT angiography]]''' is generally the initial imaging method 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'''
|-
|[[File:AoDissect DeBakey1.png|90px]]
|[[File:AoDissect DeBakey2.png|90px]]
|[[File:AoDissect DeBakey3.png|90px]]
|- 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.

==References==
{{reflist}}

@@ Line 6: / Line 6: @@
 ==Planning==
 {{Aortic dissection - indication and choice of modality}}
 {{Bottom}}

@@ Line 5: / Line 5: @@
 ==Planning==
-===Need of investigation===
+{{Aortic dissection - indication and choice of modality}}
 {{Bottom}}

@@ Line 25: / Line 25: @@
 |+ '''Classification of aortic dissection'''
 |-
-|[[File:AoDissect DeBakey1.png|90px]]
+|valign="top"|[[File:Aortic dissection of DeBakey type I.png|100px]]
-|[[File:AoDissect DeBakey2.png|90px]]
+|valign="top"|[[File:Aortic dissection of DeBakey type II.png|90px]]
-|[[File:AoDissect DeBakey3.png|90px]]
+|valign="top"|[[File:Aortic dissection of DeBakey type III.png|130px]]
 |- style="background:#dcdcdc;"
 |-

@@ Line 35: / Line 35: @@
 | style="text-align:center;" border="0"|DeBakey I
 | style="text-align:center;"|DeBakey II
-| style="text-align:center;"|DeBakey III|-
+| style="text-align:center;"|DeBakey III
 |}

@@ Line 5: / Line 5: @@
 ==Planning==
-===Need of modality===
+===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-features-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
@@ Line 12: / Line 12: @@
 Probability of dissection was found to be relatively low (7%) only in the absence of all 3 variables.<ref name="von KodolitschSchwartz2000"/>
-===Choice of investigation===
+===Choice of modality===
 *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==

@@ Line 1: / Line 1: @@
-{{Authors
+{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
@@ Line 44: / Line 44: @@
 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.
-==References==
+{{Bottom}}

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