Acute (type A) aortic dissection is a life-threatening condition that requires prompt
diagnosis and management. Risk factors include hypertension, pregnancy, coarctation of the
aorta, bicuspid aortic valve, inflammatory and connective tissue disorders, and prior aortic or
cardiac surgery. The typical clinical presentation includes sudden-onset severe chest pain that
may radiate to the neck or back. Although routine tests, such as an electrocardiogram (ECG),
a chest X-ray (CXR), and a D-dimer may raise the suspicion of aortic dissection, none is
sufficient as the sole diagnostic test. A triple rule-out computed tomography (CT) scan has a
high negative predictive value for excluding acute coronary syndrome, pulmonary embolism,
and aortic dissection in patients who present with an undifferentiated chest pain syndrome,
negative cardiac biomarkers, and a non-diagnostic ECG. Patients presenting with conditions
that predispose them to aortic dissection or high-risk features in a history or on a physical
examination should undergo definitive diagnostic imaging of the aorta. CT is the most
frequently used imaging modality because of its availability, speed, and high sensitivity and
specificity. Transesophageal echocardiography, which offers sensitivity and specificity
similar to that of CT, can be used with unstable patients. Currently, magnetic resonance
imaging (MRI) is infrequently used in acute settings because image acquisition times are
longer and the modality is less widely available. However, newer imaging sequences that can
be done rapidly without breath-holding and without an intravenous contrast medium may
increase the utility of MRI in the future.
Keywords: Acute aortic syndrome, Acute coronary syndrome, Acute type A
aortic dissection, Aortic dissection, Aortography, Biomarker, Chest radiograph,
Computed tomography, D-dimer, Echo-cardiogram, Intimal flap, Intramural
hematoma, magnetic resonance imaging, Magnetic resonance imaging,
Mediastinal width, Multidetector CT, Penetrating atherosclerotic ulcer,
Transesophageal echocardiography, Transthoracic, Triple rule-out.
