Acute Aortic Disease.. - Index of

Putting It All Together: Symptoms, Signs, and Images 75
Figure 3 (A) and (B) Signs and symptoms predicting death in acute Type A aortic dissection.
Advanced age, female sex, abrupt onset of pain, abnormal EKG, and especially pulse
deficit, kidney failure, and shock all have adverse impact on outcome. Abbreviation: ECG,
electrocardiogram. Source: From Ref. 2.
advanced imaging. Thus, the acute aortic conditions consist of a spectrum of clinically
indistinguishable and inter-related high-risk lesions that may, ultimately,
manifest as overt acute aortic dissection (15,18,21,40,41).
In the setting of presumed acute aortic condition, the purpose of diagnostic
imaging is to confirm the diagnosis, identify key characteristics, and assess cardiac
and valvular function (Table 5) (13). The choice of imaging modality depends on
several factors, including the clinical condition of the patient as well as institutionspecific
variables such as cost, availability of equipment, and local expertise.
As all modern modalities [computed tomography (CT) scan, magnetic resonance
imaging (MRI), transthoracic echocardiography (TTE) and transesophageal echocardiography
(TEE)] have suitably high accuracy and sensitivity, the most readily
available and rapidly accessible noninvasive test should be selected first. Because
of the potential for false negative findings, all patients with at least moderate
pre-test suspicion for acute aortic syndrome should undergo a second test if the
initial imaging study is negative or only “suggestive” of acute aortic pathology
(5,39,42). From our experience with IRAD, the majority of patients with acute
dissection require two imaging tests to confirm the diagnosis and provide
essential supporting data. The most common combination of imaging modalities
is CT and echocardiography (Figs. 4A and B). Aortography and MRI are more