Aortic dissection chest x ray: Difference between revisions
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==Overview== | ==Overview== | ||
Chest x-ray may be helpful in the diagnosis of aortic dissection. Findings suggestive of aortic dissection on x-ray include widening of mediastinum, wide aortic contour, tracheal deviation, aortic kinking, and displacement of | |||
==Chest X Ray== | ==Chest X Ray== | ||
Findings on chest x-ray suggestive of aortic dissection include:<ref name="pmid14715319">{{cite journal |vauthors=von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T |title=Chest radiography for the diagnosis of acute aortic syndrome |journal=Am. J. Med. |volume=116 |issue=2 |pages=73–7 |date=January 2004 |pmid=14715319 |doi=10.1016/j.amjmed.2003.08.030 |url=}}</ref> | |||
* [[Wide mediastinum|Widening of mediastinum]] | * [[Wide mediastinum|Widening of mediastinum]] | ||
* | * Wide aortic contour | ||
* Tracheal deviation | |||
* Aortic kinking | |||
* The [[calcium]] sign - separation of the [[intima]]l [[calcification]] from the outer [[aortic]] soft [[tissue]] border by 10 mm | * The [[calcium]] sign - separation of the [[intima]]l [[calcification]] from the outer [[aortic]] soft [[tissue]] border by 10 mm | ||
* [[Pleural effusion]]s may be noted | * [[Pleural effusion]]s may be noted | ||
According to one study, the following features were more likely to be observed on chest x-ray: | |||
* Aortic kinking or tortuosity | |||
* | * Displacement of previous calcification | ||
* | * Wide aortic contour | ||
* | |||
A 'normal' chest x-ray does not rule out the possibility of an [[aortic]] dissection.<ref name="HartnellWakeley1993">{{cite journal|last1=Hartnell|first1=G. G.|last2=Wakeley|first2=C. J.|last3=Tottle|first3=A.|last4=Papouchado|first4=M.|last5=Wilde|first5=R. P. H.|title=Limitations of Chest Radiography in Discriminating Between Aortic Dissection and Myocardial Infarction|journal=Journal of Thoracic Imaging|volume=8|issue=2|year=1993|pages=152–155|issn=0883-5993|doi=10.1097/00005382-199321000-00008}}</ref><br> | A 'normal' chest x-ray does not rule out the possibility of an [[aortic]] dissection.<ref name="HartnellWakeley1993">{{cite journal|last1=Hartnell|first1=G. G.|last2=Wakeley|first2=C. J.|last3=Tottle|first3=A.|last4=Papouchado|first4=M.|last5=Wilde|first5=R. P. H.|title=Limitations of Chest Radiography in Discriminating Between Aortic Dissection and Myocardial Infarction|journal=Journal of Thoracic Imaging|volume=8|issue=2|year=1993|pages=152–155|issn=0883-5993|doi=10.1097/00005382-199321000-00008}}</ref><br> | ||
In 12 to 20% of the cases presenting with [[symptom]]s and clinical features suggestive of [[aortic]] dissection, the chest x-ray is normal making it imperative to rule out dissection using other standard imaging modalities like [[echocardiography]], [[MRI]] and [[CT]]. | In 12 to 20% of the cases presenting with [[symptom]]s and clinical features suggestive of [[aortic]] dissection, the chest x-ray is normal making it imperative to rule out dissection using other standard imaging modalities like [[echocardiography]], [[MRI]] and [[CT]]. | ||
* Chest x-ray sensitivity for the diagnosis of aortic disease is 64%.<ref name="pmid14715319">{{cite journal |vauthors=von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T |title=Chest radiography for the diagnosis of acute aortic syndrome |journal=Am. J. Med. |volume=116 |issue=2 |pages=73–7 |date=January 2004 |pmid=14715319 |doi=10.1016/j.amjmed.2003.08.030 |url=}}</ref> | |||
* Chest x-ray specificity for the diagnosis of aortic disease is 86%. | |||
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease(DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>== | ==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease(DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>== | ||
===Screening Tests (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>=== | ===Screening Tests (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>=== | ||
Revision as of 19:12, 26 November 2019
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Chest x-ray may be helpful in the diagnosis of aortic dissection. Findings suggestive of aortic dissection on x-ray include widening of mediastinum, wide aortic contour, tracheal deviation, aortic kinking, and displacement of
Chest X Ray
Findings on chest x-ray suggestive of aortic dissection include:[1]
- Widening of mediastinum
- Wide aortic contour
- Tracheal deviation
- Aortic kinking
- The calcium sign - separation of the intimal calcification from the outer aortic soft tissue border by 10 mm
- Pleural effusions may be noted
According to one study, the following features were more likely to be observed on chest x-ray:
- Aortic kinking or tortuosity
- Displacement of previous calcification
- Wide aortic contour
A 'normal' chest x-ray does not rule out the possibility of an aortic dissection.[2]
In 12 to 20% of the cases presenting with symptoms and clinical features suggestive of aortic dissection, the chest x-ray is normal making it imperative to rule out dissection using other standard imaging modalities like echocardiography, MRI and CT.
- Chest x-ray sensitivity for the diagnosis of aortic disease is 64%.[1]
- Chest x-ray specificity for the diagnosis of aortic disease is 86%.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease(DO NOT EDIT)[3]
Screening Tests (DO NOT EDIT)[3]
| Class I |
| "1. The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient's pretest risk of disease as follows: |
| a. Intermediate risk: Chest x-ray should be performed on all intermediate-risk patients, as it may establish a clear alternate diagnosis that will obviate the need for definitive aortic imaging. (Level of Evidence: C) |
| b. Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. (Level of Evidence: C)" |
| Class III (No Benefit) |
| " 1. A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T (January 2004). "Chest radiography for the diagnosis of acute aortic syndrome". Am. J. Med. 116 (2): 73–7. doi:10.1016/j.amjmed.2003.08.030. PMID 14715319.
- ↑ Hartnell, G. G.; Wakeley, C. J.; Tottle, A.; Papouchado, M.; Wilde, R. P. H. (1993). "Limitations of Chest Radiography in Discriminating Between Aortic Dissection and Myocardial Infarction". Journal of Thoracic Imaging. 8 (2): 152–155. doi:10.1097/00005382-199321000-00008. ISSN 0883-5993.
- ↑ 3.0 3.1 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter
|month=ignored (help)