Aortic dissection diagnostic study of choice

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

Overview


High Risk Pain Characteristics	Score
High Risk Conditions	Score
Connective tissue disorders including Marfan syndrome	1
Family history of aortic disease
Personal history aortic valve disease
Personal history of thoracic aortic aneurysm
Previous aortic surgery (including cardiac surgery)
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)
Hypotension or shock


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

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)"

Class I
"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.(Level of Evidence: C)"

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)"

↑ ^1.0 ^1.1 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.