Emergencies in Clinical Radiology
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Cite
Extract
Aortic dissection
A spontaneous longitudinal split in the media of the aortic wall.
Aetiology and epidemiology
The pathogenesis is unclear. The following are risk factors:
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Clinical features
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Classification
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Imaging
Radiographs
This is of limited use as a first-line investigation but when performed may show a widened mediastinum (>8cm on PA CXR). This should always be compared to previous films when available. Other suggestive signs are:
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US
Transoesophageal echo has a high sensitivity and specificity.
CT
Protocol
NECT of the chest to look for high density intramural haematoma.
CECT: Bolus tracking or triggering can be used. Arterial phase imaging through the chest and abdomen to the aortic bifurcation to assess extent of dissection and involvement of major branches. If available, ECG-gating should be used to help to reduce the number of false-positive studies secondary to aortic root movement. ECG-gating may also help to identify involvement of the coronary arteries and will allow a full assessment of the coronaries prior to surgical intervention.
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