Overview
What is the definition of aortic dissection?
What are the signs and symptoms of aortic dissection?
How is aortic dissection diagnosed?
Which physical findings suggest aortic dissection?
Which lab study results suggest aortic dissection?
What is the role of chest radiography in the diagnosis of aortic dissection?
What is the role of CT scanning in the diagnosis of aortic dissection?
What is the role of echocardiography in the diagnosis of aortic dissection?
What is the role of MRI in the diagnosis of aortic dissection?
What is the role of aortography in the diagnosis of aortic dissection?
How is acute aortic dissection treated?
What does medical management for aortic dissection include?
When is emergency surgical correction of aortic dissection indicated?
What is the prognosis of aortic dissection?
What is needed to diagnose aortic dissection?
What are the treatment options for aortic dissection?
When was aortic dissection first documented, and when were effective treatments first developed?
What anatomy is relevant in aortic dissection?
What is the anatomical significance of the media in aortic dissection?
What is the anatomical significance of the adventitia in aortic dissection?
What is the role of the aorta?
What is the anatomy of the aorta?
What is the role of elasticity and distensibility in aortic dissection?
What is the pathophysiology of aortic dissection?
Where do most classic aortic dissections begin?
What are the major anatomical classification schemes for aortic dissection?
What are risk factors for development of aortic dissection?
What are congenital causes of aortic dissection?
What causes acquired aortic dissection?
What is the role of cystic medial necrosis in the pathophysiology of aortic dissection?
What causes iatrogenic aortic dissection?
What is the prevalence of aortic dissection?
What is the prognosis of aortic dissection?
Presentation
What are the signs and symptoms of aortic dissection?
What are the neurologic signs and symptoms of aortic dissection?
What are symptoms of Horner syndrome in patients with aortic dissection?
What are the cardiovascular symptoms of aortic dissection?
What are the respiratory symptoms of aortic dissection?
How should pain be assessed in the evaluation of aortic dissection?
Which blood pressure finding should increase the suspicion of aortic dissection?
Which signs of aortic regurgitation are characteristic of aortic dissection?
What are the cardiovascular findings characteristic of aortic dissection?
Which physical findings are characteristic of right coronary artery ostial dissection?
Which neurologic deficits are characteristic of aortic dissection?
What are the manifestation of peripheral nerve ischemia in aortic dissection?
What are diagnostic clues for aortic dissection?
What are potential complications of aortic dissection?
DDX
How is aortic dissection differentiated from acute myocardial infarction (MI)?
What are the differential diagnoses for Aortic Dissection?
Workup
How is aortic dissection diagnosed?
Which blood studies are performed in the workup of aortic dissection?
What is the role of smooth-muscle myosin heavy-chain assay in the workup of aortic dissection?
What is the role of chest radiography in the workup of aortic dissection?
How is aortic dissection from a widened mediastinum on chest radiography?
What is the radiographic appearance of hemothorax in aortic dissection?
Which radiographic abnormalities are characteristic of aortic dissection?
What is the role of CT in the workup of aortic dissection?
What are the limitations of CT in the workup of aortic dissection?
How does aortic dissection appear on CT scans?
What is the role of echocardiography in the workup of aortic dissection?
What is the role of MRI in the workup of aortic dissection?
What are limitations of MRI in the workup of aortic dissection?
What is the role of aortography in the workup of aortic dissection?
What are limitations to aortography in the workup of aortic dissection?
What is the role of electrocardiography in the workup of aortic dissection?
Treatment
What are the treatment options for aortic dissection?
What studies are used to guide medical therapy for aortic dissection?
Which medications are used to reduce cardiac contractility in aortic dissection?
Which medications are used to reduce systemic arterial pressure in aortic dissection?
When is beta-blocker therapy contraindicated in the treatment of aortic dissection?
When is calcium channel blocker therapy contraindicated in the treatment of aortic dissection?
When is nitroprusside infusion contraindicated in the treatment of aortic dissection?
What are the major goals of surgical intervention for aortic dissection?
What are the benefits of impermeable grafts in the treatment of aortic dissection?
Why are aortic dissections involving the arch more complicated to treat?
What are postoperative complications of aortic dissection?
What is the role of endovascular therapy in the treatment of aortic dissection?
What is included in preoperative care for aortic dissection?
What are the objectives of surgery for aortic dissection?
How are type A aortic dissections surgically managed?
When is surgical management of type B aortic dissection indicated?
How is surgical management of type B aortic dissections performed?
How is endovascular repair of aortic dissection performed?
How are intramural hematomas and penetrating ulcers in aortic dissections managed?
Which specialist consultations are needed for the treatment of aortic dissection?
What is included in long-term care of aortic dissection?
Medications
What are the initial therapeutic goals for aortic dissection?
Which medications in the drug class Analgesics are used in the treatment of Aortic Dissection?
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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.
