Aortic dissection diagnostic study of choice: Difference between revisions

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===Diagnostic Work-up of Patients Suspicious of Acute Aortic Syndrome (DO NOT EDIT)<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>===
===Diagnostic Work-up of Patients Suspicious of Acute Aortic Syndrome (DO NOT EDIT)===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
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|bgcolor="LightGreen" |<nowiki>"</nowiki>''Initial recommended [[imaging]] study for the [[diagnosis]] of [[acute aortic syndrome]] is [[transthoracic echocardiography]].([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>''Initial recommended [[imaging]] study for the [[diagnosis]] of [[acute aortic syndrome]] is [[transthoracic echocardiography]]. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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|bgcolor="LightGreen" |<nowiki>"</nowiki>''In case of initially negative [[imaging]] study, repetitive [[imaging]] study (including [[CT]] or [[MRI]]) is recommended if the suspicion for [[acute aortic syndrome]] is high.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In case of initially negative [[imaging]] study, repetitive [[imaging]] study (including [[CT]] or [[MRI]]) is recommended if the suspicion for [[acute aortic syndrome]] is high. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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|bgcolor="LightGreen" |<nowiki>"</nowiki>''Repeated [[imaging]] study (including [[CT]] or [[MRI]]) is recommended in case of uncomplicated medially treated aortic dissection type B in the first few days of treatment. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>''Repeated [[imaging]] study (including [[CT]] or [[MRI]]) is recommended in case of uncomplicated medially treated aortic dissection type B in the first few days of treatment. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In [[patients]] with hemodynamic stability, [[transoesophageal echocardiography]] or [[computed tomography]] are the recommended [[imaging]] studies. prefered modality is chosen according to local availabilty or expertise.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In [[patients]] with hemodynamic stability, [[transoesophageal echocardiography]] or [[computed tomography]] are the recommended [[imaging]] studies. preferred modality is chosen according to local availability or expertise. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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===Patients with Stable Hemodynamic<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>===
===Patients with Stable Hemodynamic<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>===
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In stable [[patients]], [[computed tomography]] or [[magnetic resonance imaging]] are the recommended [[imaging]] studies. prefered modality is chosen according to local availabilty or expertise.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In stable [[patients]], [[computed tomography]] or [[magnetic resonance imaging]] are the recommended [[imaging]] studies. prefered modality is chosen according to local availabilty or expertise. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon" |<nowiki>"</nowiki>''In stable [[patients]], [[transoesophageal echocardiography]] is the recommended [[imaging]] study.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon" |<nowiki>"</nowiki>''In stable [[patients]], [[transoesophageal echocardiography]] is the recommended [[imaging]] study. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
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==References==
==References==
<references />
<references />

Revision as of 19:49, 10 December 2019

Aortic dissection Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Special Scenarios

Management during Pregnancy

Case Studies

Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Diagnostic Study of Choice

Clinical Criteria

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)

Risk Stratification of Patients Suspicious for Aortic Dissection

High Risk Conditions Score
1
High Risk Pain Characteristics Score
  • Chest, back, or abdominal pain with at least one of the following features:
    • Abrupt onset
    • Severe intensity
    • Ripping or tearing
 1
High Risk Physical Findings Score
  • Evidence of insufficient blood supply:
    • Absent pulse
    • Systolic blood pressure difference
    • Focal neurological deficit (along with pain)
 1
  • Aortic diastolic murmur (new and with pain)

Comparison of Various Diagnostic Modalities for the Diagnosis of Aortic Dissection (DO NOT EDIT)

Location Diagnostic Modality Diagnostic Value
Ascending Aortic Dissection
  • Transthoracic Echocardiography
  • Moderate
  • Transoesophageal Echocardiography
  • Excellent
  • CT Scan
  • Excellent
  • MRI
  • Excellent
Aortic Arch Dissection
  • Transthoracic Echocardiography
  • Poor
  • Transoesophageal Echocardiography
  • Poor
  • CT Scan
  • Excellent
  • MRI
  • Excellent
Descending Aortic Dissection
  • Transthoracic Echocardiography
  • Poor
  • Transoesophageal Echocardiography
  • Excellent
  • CT Scan
  • Excellent
  • MRI
  • Excellent

Diagnostic Work-up of Patients Suspicious of Acute Aortic Syndrome (DO NOT EDIT)

Class I
"Initial recommended imaging study for the diagnosis of acute aortic syndrome is transthoracic echocardiography. (Level of Evidence: C)"
"In case of initially negative imaging study, repetitive imaging study (including CT or MRI) is recommended if the suspicion for acute aortic syndrome is high. (Level of Evidence: C)"
"Repeated imaging study (including CT or MRI) is recommended in case of uncomplicated medially treated aortic dissection type B in the first few days of treatment. (Level of Evidence: C)"

Patients with Unstable Hemodynamic

Class I
"In patients with hemodynamic stability, transoesophageal echocardiography or computed tomography are the recommended imaging studies. preferred modality is chosen according to local availability or expertise. (Level of Evidence: C)"

Patients with Stable Hemodynamic[1]

Class I
"In stable patients, computed tomography or magnetic resonance imaging are the recommended imaging studies. prefered modality is chosen according to local availabilty or expertise. (Level of Evidence: C)"
Class IIa
"In stable patients, transoesophageal echocardiography is the recommended imaging study. (Level of Evidence: C)"

References

  1. ↑ Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
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