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Aortic Dissection Differential Diagnoses

  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Dec 02, 2015
 
 

Diagnostic Considerations

Consider thoracic aortic dissection in the differential diagnosis of all patients presenting with chest pain. The pain is usually localized to the front or back of the chest, often the interscapular region, and typically migrates with propagation of the dissection.

The pain of aortic dissection is typically distinguished from the pain of acute myocardial infarction by its abrupt onset, though the presentations of the two conditions overlap to some degree and are easily confused. Aortic dissection can be presumed in patients with symptoms and signs suggestive of myocardial infarction but without classic electrocardiographic findings.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Society of Thoracic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Acknowledgements

Ali Hmidi, MD Staff Physician, Department of Internal Medicine, Brooklyn Hospital Center, Cornell University

Disclosure: Nothing to disclose.

Sateesh Kesari, MBBS, MD Fellow in Cardiovascular Medicine, New York Presbyterian Hospital/The Brooklyn Hospital Center Program, Weill Cornell Medical College of Cornell University

Sateesh Kesari, MBBS, MD is a member of the following medical societies: American College of Cardiology, American Medical Assocation, American Society of Echocardiography, and American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Oladayo Adisa Osinuga Sr, MBBS Attending Physician, Department of Internal Medicine, Atlanta Medical Center

Oladayo Adisa Osinuga Sr, MBBS is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Ramachandra C Reddy, MD Associate Director, Assistant Professor, Department of Surgery, Division of Cardiothoracic Surgery, State University of New York-Downstate Medical Center

Ramachandra C Reddy, MD is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American Medical Association, American Society for Artificial Internal Organs, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Sarath Reddy, MD Associate Director of Cardiac Care Unit, Department of Cardiology, The Brooklyn Hospital Center, Weill Medical College of Cornell University

Sarath Reddy, MD is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Benson B Roe, MD Emeritus Chief, Division of Cardiothoracic Surgery, Emeritus Professor, Department of Surgery, University of California at San Francisco Medical Center

Benson B Roe, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, American Society for Artificial Internal Organs, American Surgical Association, California Medical Association, Society for Vascular Surgery, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

Vincent Lopez Rowe, MD Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Aortic dissection. CT scan showing a flap (right side of image).
Aortic dissection. True lumen versus false lumen in an intimal flap.
Aortic dissection. Left subsegmental atelectasis and left pleural effusion. Flap at lower right of image.
Aortic dissection. Significant left pleural effusion.
Aortic dissection. CT scan showing a flap (center of image).
Aortic dissection. CT scan showing a flap (center of image).
Aortic dissection. CT scan showing a flap.
Aortic dissection. CT scan showing a flap.
Aortic dissection. Mediastinal widening.
Aortic dissection. CT scan showing a flap.
Aortic dissection. CT scan showing a flap.
Aortic dissection. CT scan showing a flap.
Aortic dissection. Thrombus and a patent lumen.
Aortic dissection. Thrombus.
Aortic dissection. True lumen and false lumen separated by an intimal flap.
Aortic dissection. Mediastinal widening.
Aortic dissection. CT scan showing a flap.
Aortic dissection. Intimal flap and left pleural effusion.
Image A represents a Stanford A or a DeBakey type 1 dissection. Image B represents a Stanford A or DeBakey type II dissection. Image C represents a Stanford type B or a DeBakey type III dissection. Image D is classified in a manner similar to A but contains an additional entry tear in the descending thoracic aorta. Note that a primary arch dissection does not fit neatly into either classification.
Aortic dissection.
Chest radiograph of a patient with aortic dissection. Image courtesy of Dr. K. London, University of California at Davis Medical Center.
Chest radiograph of a patient with aortic dissection presenting with hemothorax.
Chest radiograph demonstrating widened mediastinum in a patient with aortic dissection.
Angiogram demonstrating dissection of the aorta in a patient with aortic dissection presenting with hemothorax.
Electrocardiogram of a patient presenting to the ED with chest pain; this patient was diagnosed with aortic dissection.
Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
 
 
 
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