Aortic dissection can be rapidly fatal, with many patients dying before presentation to the emergency department (ED) or before diagnosis is made in the ED.No one sign or symptom can positively identify 1. Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. The 3 diagnoses are considered as part of the same spectrum of disease and are investigated and treated similarly. On finding extensive descending aortic dissection extending into the abdominal aorta and left common carotid artery, further CTA was performed of the neck, abdomen and pelvis as well as a ECG-gated CTA of the aortic root. 15. Acute dissection of the descending aorta: noncommunicating versus communicating forms. 3. In a very small minority, an underlying connective tissue disorder may be present. Depending on the extent of dissection and occlusion of aortic branches, end-organ ischemia may also be present (seen in up to 27% of cases) 5, including: If the aortic dissection involves the aortic root it may result in involvement of the coronary arteries and can present similarly to ST-elevation myocardial infarction on an ECG. Age-related presentation of acute type A aortic dissection. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. 1991; 180: 297 – 305. In such instances, a number of features are helpful 3: Chronic dissection flaps are often thicker and straighter than those seen in acute dissections 3. (2013) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 77 (6): 2012-20; discussion 2020. Primer of Diagnostic Imaging, Expert Consult- Online and Print. Along with the DeBakey classification, the Stanford classification 7 is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. 2010;30 (2): 445-60. Complications of all types of aortic dissection include: A Stanford type A dissection may also result in: Although the combination of blood pressure control and surgical intervention has significantly lowered in-hospital mortality, it remains significant, at 10-35%. Clinical presentation may include chest or mid-scapular back pain, signs of external chest trauma or hemodynamic instability. AJR Am J Roentgenol. 360: k678. 19 (1): 45-60. The Chest X-Ray: A Survival Guide. American surgical consensus (2020) 5 defines types A and B according to the location of the intimal tear (both types with additional qualifiers for proximal and distal extent): In contrast, a European surgical consensus document (2018) 6 recognizes dissections of the arch without involvement of the ascending aorta as a distinct category, termed "non-A-non-B dissection": ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":918,"mcqUrl":"https://radiopaedia.org/articles/aortic-dissection/questions/198?lang=us"}. Rogers AM, Hermann LK et al. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 … The Stanford classification divides dissections by the most proximal involvement: A special case that is neither reflected in the original Stanford nor the DeBakey classification are dissections that involve the aortic arch but not the ascending aorta (between 8 and 15% of all aortic dissections 4). Emergent surgical repair of aortic dissection and resuspension of aortic valve. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. MR imaging showed a marginal high-intensity area along the aortic wall, while CT showed a nonopacified crescentic area along the aortic … Stanford classification of aortic dissection, Stanford classification of aortic dissections. Aortitis is a pathologic term for the presence of inflammatory changes of the aortic wall, regardless of the underlying cause. (2018) BMJ (Clinical research ed.). (2018) Circulation. 17. AJR Am J Roentgenol. (2014) Radiology. Petasnick JP, Radiologic evaluation of aortic dissection. Over the 10 years following diagnosis another 15-30% of patients require surgery for life-threatening complications 5. Aortic dissection makes up one of the Acute Aortic Syndromes (AAS). The diagnosis of aortic aneurysms and aortic dissection has been revolutionized by developments in cross-sectional imaging. AJR Am J Roentgenol. 2018 Oct 31. Approximately 60% of dissections involve the ascending aorta (Stanford A or DeBakey I and II) 5. 57 (2): 165-198. No signs of right ventricular strain. (2004) The Annals of thoracic surgery. 271 (3): 848-55. 3. Lai V, Tsang WK, Chan WC et-al. 18. 3 4. 2005;184 (4): 1225-30. The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen. Aortic dissection ( 85-90% of AAS) – involves a tear of the intimal layer of the aorta, with the formation of a false lumen and anterograde or retrograde expansion Srichai MB, Lieber ML, Lytle BW, Kasper JM, White RD. Pereles FS, Mccarthy RM, Baskaran V et-al. In those who make it to hospital, clinical diagnosis is difficult. 1 Aortic dissection and aortic aneurysm surgery: Clinical observations, experimental investigations, and statistical analyses part III A variety of imaging modalities are available in the emergency department, though CT angiography is the most widely used definitive study for this condition. The aortic knob was very enlarged and had displaced the trachea to the right. 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