Aortic dissection chest x ray

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

An increased aortic diameter is the most common finding on chest X ray, and is observed in up to 84% of patients. A widened mediastinum is the next most common finding, and is observed in 15-20% of patients. The chest X-Ray is normal in 17% of patients. A pleural effusion (hemothorax) in the absence of congestive heart failure can be another sign of aortic dissection.

Chest X Ray

Characteristic findings on chest x-ray include:

• Widening of mediastinum
• Tracheal deviation
• The calcium sign - separation of the intimal calcification from the outer aortic soft tissue border by 10 mm
• Pleural effusions may be noted

Other minor findings include:

• Obliteration of the aortic knob
• Depression of the left main bronchus
• Loss of the para-tracheal stripe

A 'normal' chest x-ray does not rule out an aortic dissection. In 12 to 20% of the cases presenting with symptoms and clinical features suggestive of aortic dissection a normal chest x-ray is observed making it imperative to rule out dissection using other standard imaging modalities like echocardiography, MRI and CT.

2010 ACC/ AHA Guideline Recommendations: Evaluation and Management of Acute Thoracic Aortic Disease - Recommendations for Screening Tests for Aortic Dissection (DO NOT EDIT)

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)"