DDx
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
Media Gallery
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Aortic dissection. CT scan showing a flap (right side of image).
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Aortic dissection. True lumen versus false lumen in an intimal flap.
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Aortic dissection. Left subsegmental atelectasis and left pleural effusion. Flap at lower right of image.
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Aortic dissection. Significant left pleural effusion.
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Aortic dissection. CT scan showing a flap (center of image).
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Aortic dissection. CT scan showing a flap (center of image).
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. Mediastinal widening.
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. Thrombus and a patent lumen.
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Aortic dissection. Thrombus.
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Aortic dissection. True lumen and false lumen separated by an intimal flap.
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Aortic dissection. Mediastinal widening.
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Aortic dissection. CT scan showing a flap.
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Aortic dissection. Intimal flap and left pleural effusion.
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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.
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Aortic dissection.
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Chest radiograph of a patient with aortic dissection. Image courtesy of Dr. K. London, University of California at Davis Medical Center.
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Chest radiograph of a patient with aortic dissection presenting with hemothorax.
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Chest radiograph demonstrating widened mediastinum in a patient with aortic dissection.
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Angiogram demonstrating dissection of the aorta in a patient with aortic dissection presenting with hemothorax.
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Electrocardiogram of a patient presenting to the ED with chest pain; this patient was diagnosed with aortic dissection.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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