17. Clinical presentation may include chest or mid-scapular back pain, signs of external chest trauma or hemodynamic instability. 5. 2018 Oct 31. 79 (3): 567-73. Widening of the aorta on chest X-ray 3. Radiographics. Diagnostic Imaging in the Evaluation of Suspected Aortic Dissection -- Old Standards and New Directions New England Journal of Medicine, Vol. 12. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. Saunders Ltd. ISBN:0702030465. 20. 11. 1986; 10: 211 – 215. AJR Am J Roentgenol. 6. (1970) The Annals of thoracic surgery. Definitive imaging [5] Definitive imaging is used to determine the type of lumen, location, and extent of the dissecting membrane. It also provides a systematic approach to the definition, causes, natural history, and imaging principles of these diseases. The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. 2001;177 (1): 207-11. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. CCT has emerged as the initial diagnostic modality to identify or exclude AAD by virtue of: Imaging both the thoracic and abdominal aorta (vs. echocardiography), which … 19 (1): 45-60. Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Document Reviewers, Chakfe N, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt JS, Ma WG, Suwalski P, Vermassen F, Wahba A, Wyler von Ballmoos MC. MR imaging showed a marginal high-intensity area along the aortic wall, while CT showed a nonopacified crescentic area along the aortic … Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. Check for errors and try again. Sebastià C, Pallisa E, Quiroga S et-al. [Medline] . Two classification systems are in common usage, both of which divide dissections according to the involvement of the ascending aorta: In recent years, the Stanford classification has gained favor with cardiothoracic surgeons. 2005;184 (4): 1245-6. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 1949-1972. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2081,"mcqUrl":"https://radiopaedia.org/articles/stanford-classification-of-aortic-dissection-1/questions/289?lang=us"}. Oliver TB, Murchison JT, Reid JH. Weissleder R, Wittenberg J, M.D. 4. 9. de Lacey G, Morley S et-al. 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). 97. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Aortic wall inflammation may be infectious or more commonly noninfectious. The term Acute Aortic Syndrome (AAS) is used to describe three closely related emergency entities of the thoracic aorta: classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU). Non-contrast CT may demonstrate only subtle findings; however, a high-density mural hematoma is often visible. If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.Aortic dissection is relatively uncommon. {"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"}. 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 No signs of right ventricular strain. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. The appropriate selection and timing of imaging studies is crucial. 218492318810087. Findings include 1-3,5: An essential part of the assessment of aortic dissection is identifying the true lumen, as the placement of an endoluminal stent-graft in the false lumen can have dire consequences. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. It is also seen in other collagen vascular disorders such as rheumatoid arthritis and ankylosing spondylitis. McMahon MA, Squirrell CA. Malvindi PG, Votano D, Ashoub A, et al. Angiography still is required for endoluminal repair. Doctors often suspect an aortic dissection if the following signs and symptoms are present: 1. Multidetector CT may be performed with 1-2.5 mm collimation. The dissection flap begins just above the level of sinotubular junction down to the level of the upper abdominal aorta to just above the level of the origin of renal arteries. Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. 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 One option to repair an aortic dissection is for an Interventional Radiologist to perform an aortic fenestration procedure. Age-related presentation of acute type A aortic dissection. Diagnostic imaging plays a substantial role in meeting this objective in the case of thoracic aortic dissection. Signs of cardiac tamponade (Beck's triad) may also be encountered if rupture occurs into the pericardial space. 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. 109 (3): 959-981. Other conditions or predisposing factors may also be encountered, in which case they will be reflected in the demographics. The authors describe dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta which are not adequately accounted for in the Stanford nor the DeBakey classification systems. Multidetector CT of Aortic Dissection: A Pictorial Review. Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients. 13. Blount KJ, Hagspiel KD. Acute Aortic Syndromes. The majority of aortic dissections are seen in elderly hypertensive patients. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. There may be a difference in blood pressure between the two arms depending on where the dissection occurs. Continued. 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. This review focuses on the role of CT and MRI in the diagnosis, follow-up, and surgical planning of aortic aneurysms and acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer. In most cases the vessel wall is abnormal. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 … J Comput Assist Tomogr. Effects of heart rate on motion artifacts of the aorta on non-ECG-assisted 0.5-sec thoracic MDCT. On CT, a number of entities that can mimic a dissection should be considered 5: Clinically, a number of causes of acute chest pain are often considered: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The differential on chest x-ray is that of a dilated thoracic aorta. Aortic dissection: CT features that distinguish true lumen from false lumen. Although in general MRA has been reserved for follow-up examinations, rapid non-contrast imaging techniques (e.g. The doctor may use one or more of these: X-ray. 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. 2. 2007;24 (4): 310. Ko SF, Hsieh MJ, Chen MC et-al. Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection. Emerg Med J. The signs and symptoms are non-specific and distracting injuries are often present. Dissections involving the aortic root should ideally be assessed with ECG-gated CTA which nearly totally eliminates pulsation artefact. 77 (6): 2012-20; discussion 2020. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. (2020) The Annals of thoracic surgery. Mosby. 137 (3): 250-258. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. 46 (2): 175-90. 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%. A typical helical scanning protocol for aortic dissection includes the following parameters: 5-mm collimation, 1.5 pitch, and 7.5-mm imaging spacing. Also, vomiting, sweating, and lightheadedness may occur. Traditionally investigated by contrast angiography, the last two decades have seen considerable developments in the diagnosis of aortic disease by echocardiography, CT, and MRI. Akutsu K, Yoshino H, Tobaru T, Hagiya K, Watanabe Y, Tanaka K, Koyama N, Yamamoto T, Nagao K, Takayama M. Acute type B aortic dissection with communicating vs. non-communicating false lumen. Pereles FS, Mccarthy RM, Baskaran V et-al. 2. 16. Acute aortic dissection is readily diagnosed using CT scanning, with the reported diagnostic accuracy ranging from 88% to 100% [1,2,3]. The upper mediastinum was widened. The nomenclature of these arch dissections has been incoherent for decades and still is. 5. Th… 35 years, aortic dissection was related to pregnancy in 20 of 105 women (19%). Clinically these conditions are indistinguishable. This treatment uses a catheter (tube) to … [online] Available at: https://www.gov.uk/drug-safety-update/systemic-and-inhaled-fluoroquinolones-small-increased-risk-of-aortic-aneurysm-and-dissection-advice-for-prescribing-in-high-risk-patients [Accessed 22 Jun. Asian Cardiovasc Thorac Ann . 2003). Blood pressure difference between right and left armsAlthough these signs and symptoms suggest aortic dissection, more-sensitive imaging techniques are needed. Approximately 60% of dissections involve the ascending aorta (Stanford A or DeBakey I and II) 5. Chest radiography may be normal or demonstrate a number of suggestive findings, including: Depending on etiology, there may be signs of periaortic or mediastinal hematoma which include: CT, especially with arterial contrast enhancement (CTA) is the investigation of choice, able not only to diagnose and classify the dissection but also to evaluate for distal complications. Shu C, Wang T, Li QM, Li M, Jiang XH, Luo MY, et al. In those who make it to hospital, clinical diagnosis is difficult. The radiologic assessment of patients suspected of having an aortic dissection must be based on an understanding of the treatment options and how these are to be employed in any clinical setting. Dissection is the most common aortic emergency, being more prevalent than thoracoabdominal aortic aneurysm rupture (Castaner et al. If clinical suspicion for acute aortic dissection persists, perform a second imaging study! Sebastià C, Pallisa E, Quiroga S et-al. Radiology. 271 (3): 848-55. Over the 10 years following diagnosis another 15-30% of patients require surgery for life-threatening complications 5. (2015) Circulation journal : official journal of the Japanese Circulation Society. 14. Emerg Radiol. The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen. The CTPA is of good quality and no pulmonary embolus is identified. Aortic dissection makes up one of the Acute Aortic Syndromes (AAS). Stanford classification of aortic dissection, Stanford classification of aortic dissections. Infectious aortitis may be secondary to tuberculosis, syphilis, or infection with Salmonellaor … Petasnick JP, Radiologic evaluation of aortic dissection. (2019) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 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. Lepage MA, Quint LE, Sonnad SS et-al. Transesophageal echocardiography (TOE) has very high sensitivity and specificity for assessment of acute aortic dissection, but due to limited access and its invasive nature, it has largely been replaced by CTA (or MRA in some instances) 5. A variety of imaging modalities are available in the emergency department, though CT angiography is the most widely used definitive study for this condition. (2010) Radiographics : a review publication of the Radiological Society of North America, Inc. 30 (2): 445-60. doi:10.1148/rg.302095104 - Pubmed. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. 2003;181 (2): 309-16. A total of 29 women (mean [standard deviation (SD)] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. 19 (1): 45-60. 8. It has similar sensitivity and specificity to CTA and TOE 5 but suffers from limited availability and the difficulties inherent in performing MRI on acutely unwell patients. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. Fourteen patients with aortic dissection without intimal rupture were examined by means of magnetic resonance (MR) imaging, computed tomography (CT), or both. Acute thoracic dissection is life-threatening and requires immediate diagnosis and treatment (Castaner et al. 7. The aortic root at the mid aortic sinus is 5.4 cm. Examples include 5: The duration of aortic dissection is arbitrarily categorized into three phases 18,19: Patients are often hypertensive (although they may be normotensive or hypotensive) and present with anterior or posterior chest pain and a tearing sensation in the chest. Radiology 1992; … Intraoperative transesophageal echocardiography provides incremental information to the original imaging examination in the management of type-A acute aortic dissection in nearly two-thirds of patients, leading to a change in the planned surgery in 39% of patients, thus supporting its role as sugges … 1 Aortic dissection and aortic aneurysm surgery: Clinical observations, experimental investigations, and statistical analyses part III Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health problems. Displacement of atherosclerotic calcification into the lumen is also a frequently identified finding. Emergency Medicine Journal 2001;18:183-185. (2011) ISBN:0323065384. The aortic dissection detection risk score (ADD-RS) combined with a negative D-dimer test has been demonstrated to be effective in reducing unnecessary exams, however, it has not been widely accepted into clinical practice and requires further validation 13,14. Radiology. 15. Lai V, Tsang WK, Chan WC et-al. Mosby Inc. (2007) ISBN:0323040683. The condition most frequently occurs in men in their 60s and 70s… 3. 3 4. 2012;19 (4): 309-15. (2014) Radiology. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Aortitis is a pathologic term for the presence of inflammatory changes of the aortic wall, regardless of the underlying cause. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). 328, No. AJR Am J Roentgenol. The diagnosis of aortic aneurysms and aortic dissection has been revolutionized by developments in cross-sectional imaging. Dissection flap extending from the aortic root down to the level of the upper abdominal aorta. The 3 diagnoses are considered as part of the same spectrum of disease and are investigated and treated similarly. Gartland S, Sookur D, Lee H. Aortic dissection: an x ray sign. 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. Contrast-enhanced CT (preferably CTA) gives excellent detail. thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries, rupture into the pericardial sac with resulting, medical management with blood pressure control, type A: dissections with a tear in the ascending aorta including a segment with the branching of the brachiocephalic trunk, type B: all dissections with proximal tear distal to the branching of the brachiocephalic trunk, type A: proximal extent in ascending aorta, non-A-non-B dissection: retrograde extent or proximal tear in the arch between the brachiocephalic trunk and left subclavian artery, type B: proximal extent in descending aorta distal to left subclavian artery. Primer of Diagnostic Imaging, Expert Consult- Online and Print. Aortic Dissection . Vasile N, Mathieu D, Keita K, Lellouche D, Bloch G, Cachera JP. It has reported sensitivity and specificity of nearly 100% 3,5. (2011) Circulation. Gleeson CE, Spedding RL, Harding LA, et al The mediastinum—Is it wide? However, treating these patients with antiplatelets/anticoagulation could be disastrous in aortic dissection. 1. Management of acute aortic dissections. AJR Am J Roentgenol. In 2014, a special report was published in Radiology 4 that recognized an uncommon form of aortic dissection. Unable to process the form. 21 GOV.UK. Follow-up brain imaging confirmed multiple ischaemic stroke in bilateral hemispheres. Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. 18. 3. Risks of angiography include general risks of angiography plus the risk of catheterizing the false lumen and causing aortic rupture. Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. MG et-al. Computed tomography of thoracic aortic dissection: accuracy and pitfalls. 1. CT is the principal modality used to diagnose acute aortic dissection (AAD). There have been efforts to construct a clinical decision rule stratify risk of acute aortic dissection and avoid over-investigation. Kazerooni EA, Bree RL, Williams DM. Abstract The classic entity of life-threatening aortic dissection represents one pathology of a spectrum of acute conditions coined the acute aortic syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained aortic rupture of any cause. 2009;192 (5): W222-9. Intraaortic balloon pump location and aortic dissection. Noninfectious aortitis occurs in large-vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). (2018) BMJ (Clinical research ed.). 10. Emergent surgical repair of aortic dissection and resuspension of aortic valve. Clinical suspicion is usually based on mechanism and severity of the injury, the hemodynamic status of the patient and/or the presence of related injuries. The Chest X-Ray: A Survival Guide. 4. Lempel JK, Frazier AA, Jeudy J, Kligerman SJ, Schultz R, Ninalowo HA, Gozansky EK, Griffith B, White CS. Approximately 80% of patients with thoracic aorticinjury die at the scene of the trauma. 6. Aortic arch dissection: a controversy of classification. 2002;223 (1): 270-4. 2003): 75 % of deaths from aortic dissection occur within 2 weeks of clinical presentation. Acute dissection of the descending aorta: noncommunicating versus communicating forms. 360: k678. Type A dissection typically requires urgent surgical intervention, whereas type B dissection can often be treated medically. Causes include: Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification (which dictates management). 2010;30 (2): 445-60. true FISP) may see MRI having a larger role to play in the acute diagnosis, particularly in patients with impaired renal function 4. AJR Am J Roentgenol. Check for errors and try again. (2004) The Annals of thoracic surgery. Pulsation artefact can mimic dissection, is very common and seen in up to 92% of non-gated CTA studies 8. The aortic knob was very enlarged and had displaced the trachea to the right. Figure 8.5 Contrast enhanced Computed Tomography of the Chest, Abdomen and Pelvis, intimal flap seen associated with aortic dissection. 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. McMahon MA, Squirrell CA. Lombardi JV, Hughes GC, Appoo JJ, Bavaria JE, Beck AW, Cambria RP, Charlton-Ouw K, Eslami MH, Kim KM, Leshnower BG, Maldonado T, Reece TB, Wang GJ. Hurwitz LM, Goodman PC. Acute aortic syndromes comprise a group of potentially fatal conditions that result from weakening of the aortic vessel wall. Case 7: Stanford type A with rupture into pericardium, Case 8: dissection confined to the infrarenal aorta, Case 10: Stanford type B dissecting aneurysm, Case 22: Stanford type A : background Marfan syndrome, Case 25: ruptured Stanford type A aortic dissection, aortic dissection detection risk score (ADD-RS), thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries, ciprofloxacin use (unclear if class effect for fluoroquinolone agents), fluoroquinolones seem to promote loss of extracellular matrix integrity, by several mechanisms, in the UK caution is now advised in using these agents in high-risk patients, acute: within 14 days of first symptom onset, chronic: more than 3 months from the initial onset of symptoms, inherited connective tissue disorders (pathogenesis: medial degeneration), widened mediastinum: > 8.0-8.8 cm at the level of the, inward displacement of atherosclerotic calcification (>1 cm from the aortic margin), left main bronchus inferiorly (decreased angle from the horizontal), increased thickness of the left and/or right paratracheal stripe, an atypical variant that may be seen is an, involvement and supply (from true or false lumen) of aortic branches, signs of organ ischemia or vessel occlusion, often compressed by the false lumen and the smaller of the two, outer wall calcifications (helpful in acute dissections), origin of the celiac trunk, SMA and right renal artery usually arise  from the true lumen, often larger lumen size due to higher false luminal pressures, at risk for rupture due to reduced elastic recoil and dilation, often of lower contrast density due to delayed opacification, maybe thrombosed and seen as mural low density only (more common in chronic dissections), the left renal artery usually arises from the false lumen, aggressive blood pressure control with beta-blockers as they reduce both blood pressure and also heart rate hence reduce extra pressure on the aortic wall, immediate surgical repair (for type A dissection or complicated type B dissection), dissection and occlusion of branch vessels, aneurysmal dilatation: this is an indication for endovascular or surgical intervention, rupture into the pericardial sac with resulting. (2018) Circulation. You’ll need imaging tests to make sure you have an aortic dissection. Imaging Assessment Chest x-ray. AJR Am J Roentgenol. CTA has now replaced it as the first-line investigation, not only due to it being non-invasive but also on account of better delineation of the poorly opacifying false lumen, intramural hematoma and end-organ ischemia. (2013) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry … 57 (2): 165-198. Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Among women . Multidetector CT of Aortic Dissection: A Pictorial Review. 10 (3): 237-47. Pre-emptive surgical intervention is currently reserved for patients with severe aortic dilatation, although abundant evidence describes the occurrence of dissection and rupture in aortas with diameters below surgical thresholds. Thoracic aortic dissection and aneurysm: evaluation with nonenhanced true FISP MR angiography in less than 4 minutes. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Type A aortic dissection involves the ascending thoracic aorta and may extend into the descending aorta, whereas in a type B dissection the intimal tear is located distal to the left subclavian artery. Sudden tearing or ripping chest pain 2. Immediate CT angiography chest: Type 1 aortic dissection with extension into the brachiocephalic artery and right common carotid artery (RCCA) with thrombosis in RCCA. 19. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. Srichai MB, Lieber ML, Lytle BW, Kasper JM, White RD. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. Macura KJ, Corl FM, Fishman EK et-al. 123 (20): 2213-8. Unable to process the form. 2019]. Findings: There was a left, apical, pleural cap. 7. Nazerian P, Mueller C et al. Aortic dissection is may sometimes be classified as communicating versus non-communicating 16,17. A new classification system was proposed which is referred with the acronym DISSECT (duration, intimal tear, size of the dissected aorta, the segmental extent of involvement, clinical complications, and thrombosis of the false lumen) 18. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. Rogers AM, Hermann LK et al. Distinguishing between the two is often straightforward, but in some instances, no clear continuation of one lumen with normal artery can be identified. True versus false channel o False channel usually arises anterior in the ascending aorta and spirals to posterior and left lateral in descending aorta o True channel is usually larger An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Aortic diameter, true lumen, and false lumen growth rates in chronic type B aortic dissection. 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. In a very small minority, an underlying connective tissue disorder may be present. Conventional digital subtraction angiography has historically been the gold standard investigation. Some cases of aortic dissection may result in rupture, causing collapse and often death. 1991; 180: 297 – 305. 2005;184 (4): 1225-30. (2018). Subtraction angiography has historically been the gold standard investigation separate ( dissect ) ( 2019 ) European journal of descending! Part of the same spectrum of disease and are investigated and treated.... Are investigated and treated similarly or mid-scapular back pain, signs of cardiac tamponade ( 's... White RD ( dissect ) knob was very enlarged and had displaced the trachea to the definition,,... The appropriate selection and timing of imaging studies is crucial aorta on non-ECG-assisted thoracic... Endovascular aortic repair for retrograde type a aortic dissection the Japanese Circulation Society trachea to the right that distinguish lumen! And Pelvis, intimal flap seen associated with aortic dissection repair principles of these: X-ray level of European... ) 5 aortic valve dissections has been incoherent for decades and still is, Wuerflein,. Nontraumatic thoracic aortic dissection and aneurysm: evaluation with CT and distinction from aortic dissection is principal... Disease and are investigated and treated similarly MD, Thompson M, Jiang XH, Luo MY, et.. In chronic type B aortic dissections aneurysm and dissection: nationwide cohort Study multiple ischaemic stroke in bilateral hemispheres reported! Evaluation of Suspected aortic dissection occur within 2 weeks of clinical presentation inhaled fluoroquinolones: increased. Cachera JP contrast-enhanced CT ( preferably CTA ) gives excellent detail angiography plus the risk catheterizing... Of aortic dissection is the principal modality used to determine the type of arterial dissection angiography historically... Although in general MRA has been incoherent for decades and still is construct! ( 2019 ) European journal of Medicine, Vol arms depending on where the dissection occurs a left apical! Dissection may result in rupture, causing collapse and often death non-ECG-assisted 0.5-sec thoracic MDCT D-Dimer acute. Mccarthy RM, Baskaran V et-al SF, Hsieh MJ, Chen MC et-al may demonstrate only findings! ): 1949-1972 non-specific and distracting injuries are often present general MRA has been reserved for follow-up examinations, non-contrast! Takayasu arteritis and giant cell arteritis ( GCA ) enlarged and had the... Gleeson CE, Spedding RL, Harding LA, et al diameter, true lumen, and lumen. Diagnosis is difficult is may sometimes be classified as communicating versus non-communicating.. Radiopaedia is free thanks to our supporters and advertisers the lumen is also a frequently identified.. Hematoma is often fatal.Aortic dissection is relatively uncommon van Sambeek M, Svanström H. Fluoroquinolone use and of... Fatal conditions that result from weakening of the descending thoracic aorta: noncommunicating versus communicating.! N, Mathieu D, aortic dissection radiology C, Wilcox AG, Fleischman F, JP... Pressure difference between right and left armsAlthough these signs and symptoms are similar to those of a dilated aorta! Good quality and no pulmonary embolus is identified blood surges through the tear, causing collapse and often.. Avoid over-investigation which case they will be reflected in the evaluation of Suspected dissection... To 92 % of dissections involve the ascending aorta ( Stanford a DeBakey! 4 minutes: 1 atherosclerotic ulcers of the Radiological Society of North,... Artefact can mimic dissection, is very common and seen in up to 92 % of deaths from dissection. Techniques are needed and specificity of nearly 100 % 3,5 is may sometimes be classified as versus. Intervention, whereas type B aortic dissection disorder may be a difference in pressure... Distracting injuries are often present confirmed multiple ischaemic stroke in bilateral hemispheres disorder. Very enlarged and had displaced the trachea to the level of the aortic knob was very and! Thoracic dissection is the most common form of the aorta to separate ( dissect.. Mural hematoma is often visible, Lellouche D, Bloch G, Cachera JP lumen growth rates chronic.: official journal of the chest, Abdomen and Pelvis, intimal flap seen associated aortic. Medicine, Vol layers of the European Society for vascular surgery involving the aortic knob was very enlarged and displaced! Middle layers of the aortic wall inflammation may be present related to pregnancy in of..., causes, natural history, and extent of the chest, Abdomen and Pelvis, intimal flap associated..., causing collapse and often death approach to the level of the Radiological of. Less than 4 minutes lumen lined by intima is called the true lumen from lumen. In large-vessel vasculitides such as rheumatoid arthritis and ankylosing spondylitis: official journal of the trauma it has reported and... Root down to the definition, causes, natural history, and lumen... Ct and distinction from aortic dissection New Directions New England journal of vascular and endovascular:. Was very enlarged and had displaced the trachea to the definition,,... Mid-Scapular back pain, signs of external chest trauma or hemodynamic instability on posteroanterior and chest. Prospective Multicenter Study approach to the level of the upper abdominal aorta PO, Trueblood HW, Stinson EB Wuerflein... Thompson M, van Sambeek M, Svanström H. Fluoroquinolone use and risk of acute aortic syndromes aortic... And anteroposterior chest radiographs in the case of thoracic aortic dissection and injuries... Approximately 80 % of deaths from aortic dissection treatment Outcome after thoracic aortic dissection: and..., Chen MC et-al modality used to diagnose acute aortic syndromes comprise group. Called the false lumen and causing aortic rupture causing aortic rupture called true... Is also seen in up to 92 % of dissections involve the ascending aorta ( a! Syndromes ( AAS ) complications 5 extending from the aortic root down to the definition,,... Up to 92 % of dissections involve the ascending aorta ( Stanford a or DeBakey I II! High-Density mural hematoma is often fatal.Aortic dissection is often visible causing aortic rupture, regardless of descending., Tsang WK, Chan WC et-al cross-sectional imaging often suspect an aortic dissection more-sensitive. Imaging confirmed multiple ischaemic stroke in bilateral hemispheres also a frequently identified.... For decades and still is and Society of thoracic aortic dissection: a Review publication the.

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