Materiały źródłowe

• #1 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Aortic dissection is a life-threatening condition characterized by the tearing of the aortic wall, creating a false lumen that can compromise blood flow to vital organs; this condition typically presents with sudden, severe chest or back pain and may lead to catastrophic complications such as aortic rupture, cardiac tamponade, or organ ischemia. […] Early recognition, prompt imaging, and appropriate surgical or medical management are crucial for survival. […] Clinicians participating in this course gain a comprehensive understanding of the pathophysiology, diagnosis, and management of aortic dissection and insights into recent advancements in treatment modalities and patient care strategies. […] The classic presentation of acute aortic dissection involves sudden, severe, tearing chest pain, subtle presentations often lead to missed diagnoses.

• #1 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Despite the literature, many aortic dissections are missed in the emergency department; only 15% to 43% of verified cases are accurately diagnosed at first presentation. […] Without treatment, mortality approaches 50% within 48 hours of symptom onset. […] Acute aortic dissection requires prompt diagnosis and multidisciplinary healthcare intervention, with better outcomes observed in high-volume centers utilizing experienced teams, aorta code protocols, and specialized aortic centers. […] The evaluation and workup of acute aortic dissection are centered on rapid identification and confirmation of the condition, given its high mortality if left untreated. […] The diagnostic approach is guided by clinical suspicion, the patients hemodynamic stability, and the availability of imaging modalities.

• #1 Aortic Dissection: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/aortic-dissection

  Aortic dissection is defined as disruption of the medial layer of the wall of the aorta provoked by intramural bleeding, resulting in separation of the aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Acute aortic dissection (less than 14 days since onset) is distinct from subacute (15-90 days) and chronic aortic dissection (more than 90 days). […] The presentation of aortic dissection can be quite variable. It is not an easy diagnosis to make and an index of suspicion is required. […] Aortic dissection is the most common emergency affecting the aorta. […] The typical patient is a man in his 60s with hypertension and sudden onset of chest pain. […] The majority of patients with aortic dissection present with a sudden severe pain of the chest or back, classically described as 'ripping’.

• #1 Aortic dissection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/445

  Key diagnostic factors include acute severe chest pain, acute severe interscapular and lower back pain, left/right blood pressure differential, pulse deficit, diastolic murmur, features of Marfan syndrome, features of Ehlers-Danlos syndrome, syncope, and hypotension. […] 1st investigations to order include ECG, echocardiography, chest x-ray, CT (chest, abdomen, and pelvis), high-sensitivity troponin, renal function tests, liver function tests, lactate, full blood count, C-reactive protein, group and save/cross match, blood gas, creatine kinase, and procalcitonin. […] Investigations to consider include D-dimer, magnetic resonance angiography, and intravascular ultrasound.

• #1 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Definitive diagnosis of aortic dissection relies on advanced imaging to identify the intimal tear, evaluate the extent of dissection, and assess complications. […] A high-risk ADD-RS score, combined with elevated D-dimer, increases the likelihood of AAD and may justify immediate imaging. […] Prompt recognition and diagnosis of AAD are crucial to prevent catastrophic complications, including aortic rupture, cardiac tamponade, or ischemic injury to vital organs.

• #1 Aortic dissection: Prompt diagnosis and emergency treatment are critical | MDedge

  https://medauth2.mdedge.com/content/aortic-dissection-prompt-diagnosis-and-emergency-treatment-are-critical

  D-dimer levels rise in acute aortic dissection as they do in pulmonary embolism. A D-dimer level greater than 1,600 ng/mL within the first 6 hours has a very high positive likelihood ratio for dissection, so this test may be useful in identifying patients with a high probability for dissection. […] Contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE) all have very high sensitivity and specificity for the diagnosis of aortic dissection. The choice of imaging study often depends on the availability of these studies, with CT and TEE being the most commonly performed initial studies. […] When acute aortic dissection is diagnosed, multidisciplinary evaluation and treatment are necessary. Time is of the essence, as the death rate in acute dissection may be as high as 1% per hour during the first 24 hours.

• #1 Diagnosis and management of patients with aortic dissection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861401/

  The diagnosis of aortic dissection is confirmed when two lumens are separated by an intimal flap. […] Similarly, spiral CT scanning is accessible to most emergency departments, and provides similar (and even more extensive) information in suspected cases. […] The average sensitivity exceeds 95% with specificity ranging from 87-100%. […] The downside is the need for (nephrotoxic) iodinated contrast, radiation burden of 10-15mSv, and the inability to assess aortic insufficiency. […] MRI, although highly accurate, is of limited availability, especially on an emergency basis. […] Besides imaging, biomarkers for early detection of aortic dissection are recently attracting interest; a promising assay checks for circulating smooth muscle myosin heavy chain protein, a protein that is released from damaged aortic medial smooth muscle and elevated in the early hours of acute aortic dissection. […] Additional biochemical markers such as acute-phase reactants, C reactive protein, fibrinogen, soluble elastin fragments and D-dimer are also being studied.

• #1 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  All patients with suspected thoracic aortic dissection should undergo 12-lead electrocardiography (ECG). However, ECG often demonstrates a nonspecific abnormality or normal results. […] A complete blood count (CBC), serum chemistry studies, and cardiac marker assays should be performed. […] Some authors suggest that a D-dimer assay should be a part of the initial workup if aortic dissection is suspected. A negative result makes the presence of the disease less likely. […] A smooth-muscle myosin heavy-chain assay is performed in the first 24 hours. Increased levels in the first 24 hours are 90% sensitive and 97% specific for aortic dissection. […] Although chest radiography is not the definitive imaging study for aortic dissection, it should be performed as the initial imaging technique if it is readily available at the bedside and does not cause delay in obtaining CT or MRI.

• #1 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  Aortic dissection is usually diagnosed by using imaging techniques before the result of blood work is interpreted. The choice of imaging techniques depends in part on whether or not the patient is hemodynamically stable. […] Chest radiography is the initial imaging technique and may or may not reveal any abnormality. Computed tomography (CT) is useful in hemodynamically stable patients; emergency CT angiography (CTA) with three-dimensional (3D) reconstruction is rapidly becoming the diagnostic test of choice. Magnetic resonance imaging (MRI) is as accurate as CT and may benefit patients who have adverse reactions to the use of intravenous (IV) contrast agents. For hemodynamically unstable patients, echocardiography is ideal. […] Aortography is still considered by some as the diagnostic criterion standard test for aortic dissection. However, it is being replaced by newer imaging modalities.

• #1 Diagnosing Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/diagnosis

  At NYU Langone, our team of doctors works together to diagnose an aortic dissection. […] Because most aortic dissections are acutesudden and dangerousthey are typically diagnosed in the hospital. […] Your doctor may order one or more tests to help identify a tear in the aorta. […] Doctors may take an X-ray of the lungs, heart, and aorta. This can reveal a widening of the aorta, a sign of a dissection. […] CT scans use X-rays to create cross-sectional computer images of the chest and the abdomen. […] A transesophageal echocardiogram can be performed at the bedside in the hospital. […] An MRI scan helps your doctor determine the location and size of the aortic dissection. […] A magnetic resonance angiogram, or MRA, is a type of MRI scan. The test uses contrast dye, which is given through a small catheter placed in the arm, to provide clear images of the blood flow in the aorta and blood vessels.

• #1 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  CT with contrast is used more frequently in emergency department (ED) settings. CT is useful only in hemodynamically stable patients, because of its lack of portability and its potential limitations in patients with contraindications to intravenous (IV) contrast agents. […] Echocardiography is an important imaging modality for detecting aortic dissection. […] MRI has approximately 98% sensitivity and specificity for detecting thoracic aortic dissection. […] Aortography has been the diagnostic criterion standard study for aortic dissection, but it is difficult to perform in patients with hemorrhage, shock, and/or cardiac tamponade. […] All patients with suspected thoracic aortic dissection should have a 12-lead ECG. However, the ECG often demonstrates a nonspecific abnormality or normal results (approximately 31% of patients).

• #1 Aortic Dissection – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection

  Multiplanar TEE is 97 to 99% sensitive and, with M-mode echocardiography, is nearly 100% specific. […] However, CTA is typically the first-line imaging modality because it is often available more rapidly and widely than TEE. […] MRA has nearly 100% sensitivity and specificity for aortic dissection. […] Electrocardiography (ECG) is nearly universally done. However, findings range from normal to markedly abnormal (in acute coronary artery occlusion or aortic regurgitation), so the test is not diagnostically helpful for dissection itself. […] A cardiothoracic surgeon should be consulted early during the diagnostic evaluation.

• #1 Diagnosis and clinical management of aortic dissection | RRCC

  https://www.dovepress.com/diagnosis-and-clinical-management-of-aortic-dissection-peer-reviewed-fulltext-article-RRCC

  The use of magnetic resonance imaging (MRI) with or without gadolinium (magnetic resonance angiography) can also provide excellent images useful in the diagnosis of aortic dissection. […] Aortic angiography remains a highly sensitive and specific diagnostic tool that may be employed as part of an endovascular or interventional procedure. […] The speed and less invasive nature of echo, CT, and MRI has led many centers to no longer routinely obtain aortic angiograms in cases of aortic dissection. […] The use of coronary angiography remains controversial and is not recommended due to potential delay in operative management and added contrast dye load. […] A study comparing medical versus surgical management in uncomplicated type III patients showed no difference in mortality. […] Similar to the preoperative medical therapy for type I and type II dissections, medical therapy for type III dissections is targeted to reduce systemic arterial blood pressure, reduce left ventricular output (limiting dP/dt, or anti-impulse therapy), and maintain end organ profusion.

• #1 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Magnetic resonance imaging (MRI) is also used for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. […] The transesophageal echocardiogram (TEE) is a good test in the diagnosis of aortic dissection, with a sensitivity up to 98% and a specificity up to 97%. […] An aortogram involves the placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta.

• #1 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  The diagnosis is suspected based on symptoms with medical imaging, such as CT scan, MRI, or ultrasound used to confirm and further evaluate the dissection. […] Common tests used to diagnose an aortic dissection include a CT scan of the chest with iodinated contrast material and a transesophageal echocardiogram. […] The imaging technique chosen is based on the pretest likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test. […] A measurement of blood D-dimer level may be useful in diagnostic evaluation. […] Chest radiography may although demonstrate a change in the morphology of the thoracic aorta which can be seen in aortic dissection. […] Computed tomography angiography is a fast, non-invasive test that gives an accurate three-dimensional view of the aorta.

• #1 Diagnosis and management of patients with aortic dissection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861401/

  Diagnostic imaging studies in the setting of suspected aortic dissection is aimed to rapidly confirm or exclude the diagnosis, classify the extent of the dissection, and assess the emergent nature of the problem, with correct classification in distal or proximal dissection being of paramount importance. […] For confirmation of the diagnosis patients often require more than one noninvasive imaging study to characterise aortic dissection, with computed tomography (CT) used in 61% of cases, echocardiography in 33%, aortography in 4%, and magnetic resonance imaging (MRI) in only 2%. […] Upon admission in the emergent setting transthoracic echocardiography (TTE) is useful in identifying proximal aortic dissection and thus to diagnose type A dissection in patients with shock. […] Conversely, transoesophageal echocardiography (TOE) is highly diagnostic in aortic dissection encompassing the entire thoracic aorta.

• #1 Acute aortic dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-12/Acute-aortic-dissection

  Computed tomography is the most frequently performed first imaging modality, with near perfect sensitivity and specificity, however it will not evaluate aortic valve insufficiency adequately. […] Magnetic resonance imaging (MRI) also has near perfect sensitivity and specificity, and is especially suited for evaluation of chronic dissection – however it will not detect intimal tear (limited dissection) without hematoma and eccentric aortic bulge, which can only be diagnosed with aortography. […] Aortography is used when ascending aortic dissection is strongly suspected and noninvasive tests are unavailable or inconclusive. […] A recent meta-analysis by Shiga et al reviewed published studies of the diagnosis of aortic dissection by TEE, helical CT and MRI and observed that these tests have equal and reliable diagnostic value.

• #1 Types of Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/types

  Type A aortic dissection occurs in the ascending aorta, which is the curved part of the aorta that extends upward from the heart. […] Type B aortic dissection originates in the descending aorta, which extends from the arch at the top of the ascending aorta to the bottom section of the aorta, also known as the abdominal aorta. […] Most type B aortic dissections are chronic and therefore rarely cause life-threatening side effects. […] Each of these complications initiate in a different portion of the aorta. Because the risks and appropriate treatments can be markedly different depending on the type of aortic dissection, it is crucial to accurately diagnose this condition.

• #1 Diagnosis and acute management of type A aortic dissection

  https://bjcardio.co.uk/2023/04/diagnosis-and-acute-management-of-type-a-aortic-dissection/

  Following confirmation of a diagnosis of ATAD, the next step involves delineation of the proximal and distal extents of the dissection, and defining the involvement of the coronary arteries, aortic valve, supra-aortic vessels and other major branches of the descending aorta, to select the appropriate treatment strategy. […] Patients admitted to hospital with suspected ATAD should undergo baseline haematological investigations to confirm the diagnosis and analyse the severity of any associated complications. […] Elevated D-dimers should increase clinical suspicion of ATAD, since levels are usually very high following ATAD, although their diagnostic utility is greatest during the first hour. […] The diagnosis of ATAD with CT is based upon evidence of an intimal flap separating the true and false lumens, while indirect CT signs of aortic dissection include true lumen compression by the false lumen, displacement of intimal calcification, and widening of the aortic lumen. […] Once the diagnosis of ATAD has been confirmed, medical management is directed at limiting extension of the dissection and propagation of the false lumen, controlling pain, managing hypotension and determining which patients are surgical candidates.

• #1 Type B Aortic Dissection-Diagnosis, Treatment, and Management | IntechOpen

  https://www.intechopen.com/chapters/1180999

  Type B aortic dissections (TBADs) present a complex clinical challenge, characterized by diverse presentations and life-threatening complications. […] Diagnostic evaluation involves clinical assessment and imaging modalities such as CT and MRI. […] The diagnosis of TBAD relies on a combination of clinical assessment, imaging studies, and laboratory investigations. Computed tomography angiography (CTA) is the imaging modality of choice for diagnosing aortic dissections, providing detailed anatomical information regarding the extent of the dissection, involvement of branch vessels, and the presence of complications such as intramural hematoma or aortic rupture. […] The clinical presentation of TBAD can mimic various other conditions and painless dissections are not unheard of, necessitating clinicians to have a thorough differential diagnosis. […] A multidisciplinary approach involving clinical assessment, imaging studies, and laboratory investigations is essential for accurate diagnosis and optimal management of patients with TBAD.

• #1 Aortic dissection: Prompt diagnosis and emergency treatment are critical | MDedge

  https://medauth2.mdedge.com/content/aortic-dissection-prompt-diagnosis-and-emergency-treatment-are-critical

  A HIGH INDEX OF SUSPICION IS CRITICAL […] The diagnosis of acute aortic dissection has many potential pitfalls. Aortic dissection may mimic other more common conditions, such as coronary ischemia, pleurisy, heart failure, stroke, and acute abdominal illness. Because acute aortic dissection may be rapidly fatal, one must maintain a high index of suspicion. Prompt diagnosis and emergency treatment are critical. […] The focused evaluation includes specific questions about underlying conditions, symptoms, and findings on examination that may greatly increase the likelihood of acute dissection. […] Using the IRAD database of more than 2,500 acute dissections, the diagnostic algorithm proposed in the ACC/AHA guidelines was shown to be highly sensitive (about 95%) for detecting acute aortic dissection.

• #1 Acute aortic dissection: be aware of misdiagnosis | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-2-25

  Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. […] The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. […] The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT), transthoracic echocardiography (TTE) and coronary angiography. […] Initial misdiagnosis occurred in fifteen patients (31%) later found to be suffering from AAD. […] Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis. […] Despite major advances in imaging modalities and noninvasive studies, correct diagnosis is not always the rule, with misdiagnosis occurring in less than half the cases. […] The absence of suspicion rising from the patients medical history together with the heterogeneity of the clinical features of AD may lead to misdiagnosis.

• #1 Acute aortic dissection: be aware of misdiagnosis | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-2-25

  Choosing the appropriate diagnostic test may prove crucial for the survival of these patients. […] In our study the correct diagnosis of AAD was straightforward in 69% of patients, making 15 patients who were later found to have suffered an AD (31%) initially misdiagnosed. […] According to large series, confusion of AAD with acute coronary syndrome may occur in up to 45% of cases. […] Examination of cardiac troponin contributed to the correct diagnosis in only one patient of the twelve that were tested. […] Although pain is the most common presenting symptom in AAD, painless acute aortic dissection may occur in approximately 5% of patients. […] The diverse manifestations of the disease together with certain limitations in imaging studies contribute to this high rate of misguided diagnosis.

• #1 Three cases of diagnostic delay of type A acute aortic dissection | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-024-00444-y

  Diagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD. […] DD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy. […] The diagnosis of TAAAD can be made by transthoracic or transesophageal echocardiography, CT, or magnetic resonance imaging (MRI). […] Although most of the diagnosis of aortic dissection was made based on the images of CT scan with contrast material, and the diagnosis was more likely to be missed or delayed when patients presented with atypical symptoms and physicians were not willing to infuse contrast material for potential renal damage and radiation. […] A high clinical suspicion is crucial for accurate and prompt diagnosis. Aortic dissection is often misdiagnosed or diagnosed with significant delay, particularly when accompanied by less severe symptoms. A multidisciplinary and systematic approach with optimal teamwork and good communication is crucial to the diagnosis and treatment of TAAAD to improve the clinical outcome.

• #1 Acute type A aortic dissection: timeline between onset and treatment – De Vos – Journal of Visualized Surgery

  https://jovs.amegroups.org/article/view/70951/html

  Patients with acute aortic dissection are affected with high early mortality. However, only limited data is available to delineate the factors that contribute to initial delays in establishing the diagnosis and treatment. […] The median time elapsed from onset-to-presentation was 126.5 min, from presentation-to-diagnosis 85.5 min, from diagnosis-to-surgery 210 min and from onset-to-knife 600 min. The time from diagnosis-to-surgery was significantly longer than any of the other time-related variables. […] Clinical knowledge and awareness remain very important to contribute to an early admission, followed by sharp and accurate diagnosis to improve outcome. Improvement in logistics should lead to shorter diagnosis-to-surgery time. […] We know from the International Registry of Acute Aortic Dissection (IRAD) that the median time from presentation to diagnosis for all acute aortic dissection patients is over 4.3 hours.

• #1

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/thoracic-aortic-dissection

  Thoracic aortic dissection should be considered for every patient presenting to the emergency department with chest pain or back pain, particularly if accompanied by neurologic signs or symptoms. […] Prompt diagnosis and emergent surgical consultation are vital to achieve a favorable outcome, though sometimes even this is insufficient. […] A high index of suspicion must be maintained for this diagnosis given its substantial morbidity and mortality. In one series, over one-third of patients were misdiagnosed on their first presentation to the emergency department. […] Diagnostic imaging plays a substantial role in meeting this objective in the case of thoracic aortic dissection. A variety of imaging modalities are available in the emergency department, though CT angiography is the most widely used definitive study for this condition.

• #1

  https://smw.ch/index.php/smw/article/view/2356

  Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Therefore, its prompt and proper diagnosis is vital to increase a patients chance of survival and to prevent grievous complications. […] Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. […] As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective. […] Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis.

• #1

  https://link.springer.com/article/10.1007/s40138-014-0044-8

  Despite its limitations, the use of D-dimer testing is recommended by the task force of European Society of Cardiology in the initial workup of those patients suspected of AAD. […] The imaging modality of choice remains CT. MRI has a higher sensitivity but its availability in the emergency situation results in CT becoming a more amenable diagnostic tool. […] The diagnosis of AAD is challenging for the emergency physician with potentially devastating consequences. A high index of suspicion must be maintained in order to ensure expedient and accurate diagnosis.

• #1 Aortic Dissections Symptoms & Treatment – Aortic Care | UCLA Health

  https://www.uclahealth.org/medical-services/heart/aortic/aortic-conditions-diseases/aortic-dissections

  Aortic dissection occurs when damage to the inner wall of the aorta allows blood to flow in between tissue layers of the aortic wall. Aortic dissections are classified as either a Type A or Type B dissection depending on where the tear is located in the aorta. A Type A dissection occurs near where the aortic artery connects to the heart and the aortic arch. Type B dissections occur in the aorta in the chest and extend down to the abdomen. […] At the UCLA Aortic Center, our skilled team provides expert evaluation and treatment for patients with aortic dissections. […] Diagnosis of an aortic dissection can be made through a physical examination by a doctor and further confirmed through diagnostic imaging tests. These types of tests include: […] Computerized tomography (CT) scan. This test can determine the location and extent of an aortic dissection. This test may be done with the infusion of intravenous contrast, which can show areas of blood flow in the aortic dissection. […] Transesophageal echocardiogram. This test quickly and accurately evaluates the anatomy of the aorta at the patients bedside and can confirm the presence and extent of a Type A aortic dissection.

• #1 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  Transthoracic echocardiogram (TTE): This test uses ultrasound to provide moving pictures of your heart valves and chambers and the first portion of the aorta (the aortic root). […] Transesophageal echocardiogram (TEE): This test shows more detailed pictures of your heart valves and chambers than a transthoracic echocardiogram. […] Magnetic resonance imaging (MRI): This test uses a large magnet and radio waves to produce detailed images of your organs and the structures inside your body, including your aorta. […] Aortic dissection treatment depends on the location of the tear and dissection. […] For Type A aortic dissection (when it involves the first part of the aorta close to your heart), you need immediate surgery. […] For Type B aortic dissection, you need emergency surgery if the dissection cuts off blood flow to your vital organs and body parts. […] A provider may prescribe medications like beta-blockers to lower your heart rate and blood pressure.

• #2 Clinical features and diagnosis of acute aortic dissection – UpToDate

  http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-aortic-dissection

  Clinical features and diagnosis of acute aortic dissection […] Aortic dissection is relatively uncommon and often presents acutely as a catastrophic illness with severe tearing chest or back pain and acute hemodynamic compromise. Early and accurate diagnosis and treatment are crucial for survival. […] The clinical manifestations and diagnosis of acute aortic dissection will be reviewed here. […] High-risk clinical features […] Clinical triad […] Aortic dissection detection risk score (ADD-RS) […] ADD-RS plus D-dimer […] Cardiovascular imaging […] Hemodynamically unstable […] Hemodynamically stable […] Role of aortography […] Aortic dissection on noninvasive imaging […] Aortic dissection noncontrast CT […] Thoracic aortic dissection on computed tomography […] Thoracic aortic dissection on reconstructed computed tomography […] Aortogram showing descending thoracic aortic dissection.

• #2 Acute aortic dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-12/Acute-aortic-dissection

  A high index of suspicion is required for prompt diagnosis and treatment of deadly and relatively rare aortic dissection yet diagnosis is both elusive and challenging, with a diversity of manifestations, depending on where it occurs along the aorta. […] In ascending aortic dissection in particular, early diagnosis is critical: prompt intervention can reverse the mortality rate, which is estimated to increase by 1% to 1.4% in the first 48 hours. […] Classic type A dissection (involving the ascending aorta) needs rapid surgical intervention, whereas classic type B dissection (not involving the ascending aorta) requires medical management only – unless complications render surgery necessary. […] Transthoracic echo (TTE): A bedside transthoracic echo is an invaluable tool. […] Transesophageal echo (TEE) can also be performed in the emergency room for patients who present with acute chest pain and/or are hemodynamically unstable.

• #2 Aortic dissection: Prompt diagnosis and emergency treatment are critical | MDedge

  https://medauth2.mdedge.com/content/aortic-dissection-prompt-diagnosis-and-emergency-treatment-are-critical

  A HIGH INDEX OF SUSPICION IS CRITICAL […] The diagnosis of acute aortic dissection has many potential pitfalls. Aortic dissection may mimic other more common conditions, such as coronary ischemia, pleurisy, heart failure, stroke, and acute abdominal illness. Because acute aortic dissection may be rapidly fatal, one must maintain a high index of suspicion. Prompt diagnosis and emergency treatment are critical. […] The focused evaluation includes specific questions about underlying conditions, symptoms, and findings on examination that may greatly increase the likelihood of acute dissection. […] Using the IRAD database of more than 2,500 acute dissections, the diagnostic algorithm proposed in the ACC/AHA guidelines was shown to be highly sensitive (about 95%) for detecting acute aortic dissection.

• #2 Aortic Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441963/

  Aortic dissection is a life-threatening condition characterized by the tearing of the aortic wall, creating a false lumen that can compromise blood flow to vital organs; this condition typically presents with sudden, severe chest or back pain and may lead to catastrophic complications such as aortic rupture, cardiac tamponade, or organ ischemia. […] Early recognition, prompt imaging, and appropriate surgical or medical management are crucial for survival. […] Clinicians participating in this course gain a comprehensive understanding of the pathophysiology, diagnosis, and management of aortic dissection and insights into recent advancements in treatment modalities and patient care strategies. […] The classic presentation of acute aortic dissection involves sudden, severe, tearing chest pain, subtle presentations often lead to missed diagnoses.

• #2 Aortic dissection | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/aortic-dissection?lang=us

  Aortic dissection is the prototype and most common form of acute aortic syndromes and a type of arterial dissection. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks longitudinally along with the media, forming a second blood-filled channel (false lumen) within the vessel wall. […] The aortic dissection detection risk score (ADD-RS) combined with a negative D-dimer test has been demonstrated to be effective in reducing unnecessary exams, however, it has not been widely accepted into clinical practice and requires further validation. […] CT, especially with arterial contrast enhancement and specifically computed tomography angiography (CTA) of the aorta is the investigation of choice, able not only to diagnose and classify the dissection but also to evaluate for distal complications. It has reported sensitivity and specificity of nearly 100%.

• #2

  https://link.springer.com/article/10.1007/s40138-014-0044-8

  Despite its limitations, the use of D-dimer testing is recommended by the task force of European Society of Cardiology in the initial workup of those patients suspected of AAD. […] The imaging modality of choice remains CT. MRI has a higher sensitivity but its availability in the emergency situation results in CT becoming a more amenable diagnostic tool. […] The diagnosis of AAD is challenging for the emergency physician with potentially devastating consequences. A high index of suspicion must be maintained in order to ensure expedient and accurate diagnosis.

• #2 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  All patients with suspected thoracic aortic dissection should undergo 12-lead electrocardiography (ECG). However, ECG often demonstrates a nonspecific abnormality or normal results. […] A complete blood count (CBC), serum chemistry studies, and cardiac marker assays should be performed. […] Some authors suggest that a D-dimer assay should be a part of the initial workup if aortic dissection is suspected. A negative result makes the presence of the disease less likely. […] A smooth-muscle myosin heavy-chain assay is performed in the first 24 hours. Increased levels in the first 24 hours are 90% sensitive and 97% specific for aortic dissection. […] Although chest radiography is not the definitive imaging study for aortic dissection, it should be performed as the initial imaging technique if it is readily available at the bedside and does not cause delay in obtaining CT or MRI.

• #2 Aortic dissection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000226

  1st investigations to order include ECG, echocardiography, chest x-ray, CT (chest, abdomen, and pelvis), high-sensitivity troponin, renal function tests, liver function tests, lactate, full blood count, C-reactive protein, group and save/cross match, blood gas, creatine kinase, and procalcitonin. […] Investigations to consider include D-dimer, magnetic resonance angiography, and intravascular ultrasound.

• #2 Diagnosing Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/diagnosis

  At NYU Langone, our team of doctors works together to diagnose an aortic dissection. […] Because most aortic dissections are acutesudden and dangerousthey are typically diagnosed in the hospital. […] Your doctor may order one or more tests to help identify a tear in the aorta. […] Doctors may take an X-ray of the lungs, heart, and aorta. This can reveal a widening of the aorta, a sign of a dissection. […] CT scans use X-rays to create cross-sectional computer images of the chest and the abdomen. […] A transesophageal echocardiogram can be performed at the bedside in the hospital. […] An MRI scan helps your doctor determine the location and size of the aortic dissection. […] A magnetic resonance angiogram, or MRA, is a type of MRI scan. The test uses contrast dye, which is given through a small catheter placed in the arm, to provide clear images of the blood flow in the aorta and blood vessels.

• #2 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  The diagnosis is suspected based on symptoms with medical imaging, such as CT scan, MRI, or ultrasound used to confirm and further evaluate the dissection. […] Common tests used to diagnose an aortic dissection include a CT scan of the chest with iodinated contrast material and a transesophageal echocardiogram. […] The imaging technique chosen is based on the pretest likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test. […] A measurement of blood D-dimer level may be useful in diagnostic evaluation. […] Chest radiography may although demonstrate a change in the morphology of the thoracic aorta which can be seen in aortic dissection. […] Computed tomography angiography is a fast, non-invasive test that gives an accurate three-dimensional view of the aorta.

• #2 Diagnosis and management of patients with aortic dissection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861401/

  The diagnosis of aortic dissection is confirmed when two lumens are separated by an intimal flap. […] Similarly, spiral CT scanning is accessible to most emergency departments, and provides similar (and even more extensive) information in suspected cases. […] The average sensitivity exceeds 95% with specificity ranging from 87-100%. […] The downside is the need for (nephrotoxic) iodinated contrast, radiation burden of 10-15mSv, and the inability to assess aortic insufficiency. […] MRI, although highly accurate, is of limited availability, especially on an emergency basis. […] Besides imaging, biomarkers for early detection of aortic dissection are recently attracting interest; a promising assay checks for circulating smooth muscle myosin heavy chain protein, a protein that is released from damaged aortic medial smooth muscle and elevated in the early hours of acute aortic dissection. […] Additional biochemical markers such as acute-phase reactants, C reactive protein, fibrinogen, soluble elastin fragments and D-dimer are also being studied.

• #2 Diagnosis and management of patients with aortic dissection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861401/

  Diagnostic imaging studies in the setting of suspected aortic dissection is aimed to rapidly confirm or exclude the diagnosis, classify the extent of the dissection, and assess the emergent nature of the problem, with correct classification in distal or proximal dissection being of paramount importance. […] For confirmation of the diagnosis patients often require more than one noninvasive imaging study to characterise aortic dissection, with computed tomography (CT) used in 61% of cases, echocardiography in 33%, aortography in 4%, and magnetic resonance imaging (MRI) in only 2%. […] Upon admission in the emergent setting transthoracic echocardiography (TTE) is useful in identifying proximal aortic dissection and thus to diagnose type A dissection in patients with shock. […] Conversely, transoesophageal echocardiography (TOE) is highly diagnostic in aortic dissection encompassing the entire thoracic aorta.

• #2 Aortic Dissections Symptoms & Treatment – Aortic Care | UCLA Health

  https://www.uclahealth.org/medical-services/heart/aortic/aortic-conditions-diseases/aortic-dissections

  Aortic dissection occurs when damage to the inner wall of the aorta allows blood to flow in between tissue layers of the aortic wall. Aortic dissections are classified as either a Type A or Type B dissection depending on where the tear is located in the aorta. A Type A dissection occurs near where the aortic artery connects to the heart and the aortic arch. Type B dissections occur in the aorta in the chest and extend down to the abdomen. […] At the UCLA Aortic Center, our skilled team provides expert evaluation and treatment for patients with aortic dissections. […] Diagnosis of an aortic dissection can be made through a physical examination by a doctor and further confirmed through diagnostic imaging tests. These types of tests include: […] Computerized tomography (CT) scan. This test can determine the location and extent of an aortic dissection. This test may be done with the infusion of intravenous contrast, which can show areas of blood flow in the aortic dissection. […] Transesophageal echocardiogram. This test quickly and accurately evaluates the anatomy of the aorta at the patients bedside and can confirm the presence and extent of a Type A aortic dissection.

• #2 Diagnosis and clinical management of aortic dissection | RRCC

  https://www.dovepress.com/diagnosis-and-clinical-management-of-aortic-dissection-peer-reviewed-fulltext-article-RRCC

  Aortic dissection on plain chest radiography may demonstrate a widened mediastinum, particularly for type I and II dissections. […] Transthoracic echocardiography is a useful tool in critically ill patients to aid in rapid evaluation of a type A dissection, but a transesophageal echogram allows for a more accurate diagnosis. […] Echocardiography has been shown to be highly sensitive and specific for identifying type A aortic dissection and can also identify pericardial fluid, evidence of cardiac tamponade, aortic valve dysfunction, involvement of coronary arteries, and abnormal ventricular wall motion. […] Computed tomography (CT) with intravenous contrast is widely available in most emergency departments and produces high quality images useful in diagnosis of aortic dissection. […] Sensitivity with modern helical CT scanning approaches 100% and specificity is 98%.

• #2 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  CT with contrast is used more frequently in emergency department (ED) settings. CT is useful only in hemodynamically stable patients, because of its lack of portability and its potential limitations in patients with contraindications to intravenous (IV) contrast agents. […] Echocardiography is an important imaging modality for detecting aortic dissection. […] MRI has approximately 98% sensitivity and specificity for detecting thoracic aortic dissection. […] Aortography has been the diagnostic criterion standard study for aortic dissection, but it is difficult to perform in patients with hemorrhage, shock, and/or cardiac tamponade. […] All patients with suspected thoracic aortic dissection should have a 12-lead ECG. However, the ECG often demonstrates a nonspecific abnormality or normal results (approximately 31% of patients).

• #2 Diagnosis and management of thoracic aortic dissection: An update

  https://www.wjgnet.com/2220-3168/full/v5/i2/79.htm

  Differential diagnoses include myocardial infarction, pulmonary embolus, perforated viscus, stroke or other neurological insult and embolic disease. ECG and X-ray are not sensitive enough to diagnose dissection, but will identify concomitant acute coronary syndromes or act as indicators of alternative diagnoses. CT angiography remains the recommended first line investigation in those suspected of having dissection. It is also useful for planning surgical intervention. Other first line modalities include transoesophageal ECHO, which has the advantage of identifying new aortic regurgitation or pericardial effusion. However it cannot image the entire aorta, and is heavily operator dependent. Magnetic resonance angiography lacks radiation exposure, and uses less nephrotoxic agent, which benefits patients with evidence of renal hypoperfusion. However availability is more limited and imaging takes longer, making it more suitable in the chronic setting or for patient follow-up. All three of these modalities have sensitivity and specificity of over 95% for diagnosis.

• #2 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  Aortic dissection is usually diagnosed by using imaging techniques before the result of blood work is interpreted. The choice of imaging techniques depends in part on whether or not the patient is hemodynamically stable. […] Chest radiography is the initial imaging technique and may or may not reveal any abnormality. Computed tomography (CT) is useful in hemodynamically stable patients; emergency CT angiography (CTA) with three-dimensional (3D) reconstruction is rapidly becoming the diagnostic test of choice. Magnetic resonance imaging (MRI) is as accurate as CT and may benefit patients who have adverse reactions to the use of intravenous (IV) contrast agents. For hemodynamically unstable patients, echocardiography is ideal. […] Aortography is still considered by some as the diagnostic criterion standard test for aortic dissection. However, it is being replaced by newer imaging modalities.

• #2 Diagnosis and acute management of type A aortic dissection

  https://bjcardio.co.uk/2023/04/diagnosis-and-acute-management-of-type-a-aortic-dissection/

  Following confirmation of a diagnosis of ATAD, the next step involves delineation of the proximal and distal extents of the dissection, and defining the involvement of the coronary arteries, aortic valve, supra-aortic vessels and other major branches of the descending aorta, to select the appropriate treatment strategy. […] Patients admitted to hospital with suspected ATAD should undergo baseline haematological investigations to confirm the diagnosis and analyse the severity of any associated complications. […] Elevated D-dimers should increase clinical suspicion of ATAD, since levels are usually very high following ATAD, although their diagnostic utility is greatest during the first hour. […] The diagnosis of ATAD with CT is based upon evidence of an intimal flap separating the true and false lumens, while indirect CT signs of aortic dissection include true lumen compression by the false lumen, displacement of intimal calcification, and widening of the aortic lumen. […] Once the diagnosis of ATAD has been confirmed, medical management is directed at limiting extension of the dissection and propagation of the false lumen, controlling pain, managing hypotension and determining which patients are surgical candidates.

• #2 Types of Aortic Dissection | NYU Langone Health

  https://nyulangone.org/conditions/aortic-dissection/types

  Type A aortic dissection occurs in the ascending aorta, which is the curved part of the aorta that extends upward from the heart. […] Type B aortic dissection originates in the descending aorta, which extends from the arch at the top of the ascending aorta to the bottom section of the aorta, also known as the abdominal aorta. […] Most type B aortic dissections are chronic and therefore rarely cause life-threatening side effects. […] Each of these complications initiate in a different portion of the aorta. Because the risks and appropriate treatments can be markedly different depending on the type of aortic dissection, it is crucial to accurately diagnose this condition.

• #2 Acute aortic dissection: be aware of misdiagnosis | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-2-25

  Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. […] The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. […] The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT), transthoracic echocardiography (TTE) and coronary angiography. […] Initial misdiagnosis occurred in fifteen patients (31%) later found to be suffering from AAD. […] Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis. […] Despite major advances in imaging modalities and noninvasive studies, correct diagnosis is not always the rule, with misdiagnosis occurring in less than half the cases. […] The absence of suspicion rising from the patients medical history together with the heterogeneity of the clinical features of AD may lead to misdiagnosis.

• #2 Acute aortic dissection: be aware of misdiagnosis | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-2-25

  Choosing the appropriate diagnostic test may prove crucial for the survival of these patients. […] In our study the correct diagnosis of AAD was straightforward in 69% of patients, making 15 patients who were later found to have suffered an AD (31%) initially misdiagnosed. […] According to large series, confusion of AAD with acute coronary syndrome may occur in up to 45% of cases. […] Examination of cardiac troponin contributed to the correct diagnosis in only one patient of the twelve that were tested. […] Although pain is the most common presenting symptom in AAD, painless acute aortic dissection may occur in approximately 5% of patients. […] The diverse manifestations of the disease together with certain limitations in imaging studies contribute to this high rate of misguided diagnosis.

• #2 Three cases of diagnostic delay of type A acute aortic dissection | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-024-00444-y

  Diagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD. […] DD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy. […] The diagnosis of TAAAD can be made by transthoracic or transesophageal echocardiography, CT, or magnetic resonance imaging (MRI). […] Although most of the diagnosis of aortic dissection was made based on the images of CT scan with contrast material, and the diagnosis was more likely to be missed or delayed when patients presented with atypical symptoms and physicians were not willing to infuse contrast material for potential renal damage and radiation. […] A high clinical suspicion is crucial for accurate and prompt diagnosis. Aortic dissection is often misdiagnosed or diagnosed with significant delay, particularly when accompanied by less severe symptoms. A multidisciplinary and systematic approach with optimal teamwork and good communication is crucial to the diagnosis and treatment of TAAAD to improve the clinical outcome.

• #3 Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection | Scientific Reports

  https://www.nature.com/articles/s41598-021-83180-6

  There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. […] Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 812 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. […] Mortality increases in a time-dependent manner, with published data demonstrating mortality increases of 12% per hour in the first 24 h; thus, early diagnosis and treatment are paramount in achieving successful outcomes. […] However, despite the crucial importance of expeditious surgical intervention for ATAAD, there are few reports investigating the effect of time interval between diagnosis and surgery on outcomes. […] Our results demonstrate that surgical intervention within 4 h of diagnosis leads to significantly better outcomes; ATAAD must continue to be considered a time-sensitive emergency and steps taken to expedite surgery.

• #3 Aortic Dissection Workup: Approach Considerations, Blood Studies, Smooth-Muscle Myosin Heavy-Chain Assay

  https://emedicine.medscape.com/article/2062452-workup

  All patients with suspected thoracic aortic dissection should undergo 12-lead electrocardiography (ECG). However, ECG often demonstrates a nonspecific abnormality or normal results. […] A complete blood count (CBC), serum chemistry studies, and cardiac marker assays should be performed. […] Some authors suggest that a D-dimer assay should be a part of the initial workup if aortic dissection is suspected. A negative result makes the presence of the disease less likely. […] A smooth-muscle myosin heavy-chain assay is performed in the first 24 hours. Increased levels in the first 24 hours are 90% sensitive and 97% specific for aortic dissection. […] Although chest radiography is not the definitive imaging study for aortic dissection, it should be performed as the initial imaging technique if it is readily available at the bedside and does not cause delay in obtaining CT or MRI.

• #3 Diagnosis and management of patients with aortic dissection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861401/

  The diagnosis of aortic dissection is confirmed when two lumens are separated by an intimal flap. […] Similarly, spiral CT scanning is accessible to most emergency departments, and provides similar (and even more extensive) information in suspected cases. […] The average sensitivity exceeds 95% with specificity ranging from 87-100%. […] The downside is the need for (nephrotoxic) iodinated contrast, radiation burden of 10-15mSv, and the inability to assess aortic insufficiency. […] MRI, although highly accurate, is of limited availability, especially on an emergency basis. […] Besides imaging, biomarkers for early detection of aortic dissection are recently attracting interest; a promising assay checks for circulating smooth muscle myosin heavy chain protein, a protein that is released from damaged aortic medial smooth muscle and elevated in the early hours of acute aortic dissection. […] Additional biochemical markers such as acute-phase reactants, C reactive protein, fibrinogen, soluble elastin fragments and D-dimer are also being studied.

• #3 Aortic Dissection: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/aortic-dissection

  Anyone with suspected aortic disease and ECG evidence of ischaemia must have diagnostic imaging before thrombolytic therapy is started. […] CXR alone is inadequate to exclude aortic dissection. […] Transthoracic/transoesophageal ultrasound will give an indication of site and extent of dissection. […] CT scanning may be used to confirm the diagnosis but is less helpful in complications and prognosis. […] MRI scanning will confirm diagnosis, will identify involvement of other vessels and will be increasingly useful as scanning times decrease, and with better access. […] Of all of the imaging modalities it has the best sensitivity (98%) and specificity (98%) for aortic dissection. […] Surgical intervention may involve the placing of stents or grafts to the aorta but accurate assessment is essential first, as there may be entry, re-entry and multiple tears.

• #3 Diagnosis and acute management of type A aortic dissection

  https://bjcardio.co.uk/2023/04/diagnosis-and-acute-management-of-type-a-aortic-dissection/

  Following confirmation of a diagnosis of ATAD, the next step involves delineation of the proximal and distal extents of the dissection, and defining the involvement of the coronary arteries, aortic valve, supra-aortic vessels and other major branches of the descending aorta, to select the appropriate treatment strategy. […] Patients admitted to hospital with suspected ATAD should undergo baseline haematological investigations to confirm the diagnosis and analyse the severity of any associated complications. […] Elevated D-dimers should increase clinical suspicion of ATAD, since levels are usually very high following ATAD, although their diagnostic utility is greatest during the first hour. […] The diagnosis of ATAD with CT is based upon evidence of an intimal flap separating the true and false lumens, while indirect CT signs of aortic dissection include true lumen compression by the false lumen, displacement of intimal calcification, and widening of the aortic lumen. […] Once the diagnosis of ATAD has been confirmed, medical management is directed at limiting extension of the dissection and propagation of the false lumen, controlling pain, managing hypotension and determining which patients are surgical candidates.

• #3 Aortic dissection – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_dissection

  Magnetic resonance imaging (MRI) is also used for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. […] The transesophageal echocardiogram (TEE) is a good test in the diagnosis of aortic dissection, with a sensitivity up to 98% and a specificity up to 97%. […] An aortogram involves the placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta.

• #3 Three cases of diagnostic delay of type A acute aortic dissection | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-024-00444-y

  Diagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD. […] DD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy. […] The diagnosis of TAAAD can be made by transthoracic or transesophageal echocardiography, CT, or magnetic resonance imaging (MRI). […] Although most of the diagnosis of aortic dissection was made based on the images of CT scan with contrast material, and the diagnosis was more likely to be missed or delayed when patients presented with atypical symptoms and physicians were not willing to infuse contrast material for potential renal damage and radiation. […] A high clinical suspicion is crucial for accurate and prompt diagnosis. Aortic dissection is often misdiagnosed or diagnosed with significant delay, particularly when accompanied by less severe symptoms. A multidisciplinary and systematic approach with optimal teamwork and good communication is crucial to the diagnosis and treatment of TAAAD to improve the clinical outcome.

• #4 Acute Aortic Dissection • LITFL • CCC Cardiology

  https://litfl.com/acute-aortic-dissection/

  aortic dissection is a type of acute aortic syndrome (AAS) characterized by blood entering the medial layer of the wall with the creation of a false lumen. […] consider the diagnosis of acute aortic dissection if there is a combination of chest/ back pain and new or evolving neurological deficit(s) […] ECG […] D-dimer if negative dissection is very unlikely, but not sufficient to rule out […] Transthoracic […] 75% diagnostic Type A (ascending), 40% descending (Type B) […] Transoesophageal (TOE) […] Much higher sensitivity/specificity, though operator-dependent, need sedation, and is less available […] Helical CT […] Useful screen for widened mediastinum. Newer multiplane/slice scanners may now negate additional need for TOE or aortography to plan operative management. […] Aortography Was the traditional gold standard, delineating aortic incompetence and associated branch vessel involvement as well. […] MRI / MRA Excellent sensitivity and specificity limited by availability.

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