Difference between revisions of "Aortic dissection"
Jump to navigation
Jump to search
| Line 5: | Line 5: | ||
==Planning== | ==Planning== | ||
| − | ===Need of | + | ===Need of modality=== |
According to a clinical prediction rule of the American Medical Association, symptoms that best determine the risk of acute aortic dissection in patients with acute chest pain, acute back pain, or both are:<ref name="von KodolitschSchwartz2000">{{cite journal|last1=von Kodolitsch|first1=Yskert|last2=Schwartz|first2=Ann G.|last3=Nienaber|first3=Christoph A.|title=Clinical Prediction of Acute Aortic Dissection|journal=Archives of Internal Medicine|volume=160|issue=19|year=2000|pages=2977|issn=0003-9926|doi=10.1001/archinte.160.19.2977}}</ref><ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-aortic-dissection|title=Clinical features and diagnosis of acute aortic dissection|author=James H Black, III, Warren J Manning|website=UpToDate}} This topic last updated: Feb 16, 2018. Topic 8190 Version 29.0}}</ref> | According to a clinical prediction rule of the American Medical Association, symptoms that best determine the risk of acute aortic dissection in patients with acute chest pain, acute back pain, or both are:<ref name="von KodolitschSchwartz2000">{{cite journal|last1=von Kodolitsch|first1=Yskert|last2=Schwartz|first2=Ann G.|last3=Nienaber|first3=Christoph A.|title=Clinical Prediction of Acute Aortic Dissection|journal=Archives of Internal Medicine|volume=160|issue=19|year=2000|pages=2977|issn=0003-9926|doi=10.1001/archinte.160.19.2977}}</ref><ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-aortic-dissection|title=Clinical features and diagnosis of acute aortic dissection|author=James H Black, III, Warren J Manning|website=UpToDate}} This topic last updated: Feb 16, 2018. Topic 8190 Version 29.0}}</ref> | ||
*Pain in the chest or abdomen with immediate onset and a tearing or ripping character | *Pain in the chest or abdomen with immediate onset and a tearing or ripping character | ||
Revision as of 18:47, 6 November 2018
Author:
Mikael Häggström [notes 1]
Contents
Planning
Need of modality
According to a clinical prediction rule of the American Medical Association, symptoms that best determine the risk of acute aortic dissection in patients with acute chest pain, acute back pain, or both are:[1][2]
- Pain in the chest or abdomen with immediate onset and a tearing or ripping character
- Differentials in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20 mmHg difference between the right and left arm)
- Mediastinal and/or aortic widening on chest radiography
Probability of dissection was found to be relatively low (7%) only in the absence of all 3 variables.[1]
Choice of investigation
- For hemodynamically unstable patients or where a dissection of the ascending aorta is suspected, transesophageal echocardiography (TEE) is suggested as the first investigation of choice.[2]
- Hemodynamically stable patients without suspected ascending aortic involvement, CT angiography is generally the initial imaging method of choice.[2]
Evaluation
- DissectionCT.png
CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta, as a
Classification
| 90px | 90px | 90px |
| Stanford A (Proximal) | Stanford B (Distal) | |
| DeBakey I | DeBakey II | DeBakey III|- |
The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.[3]
- A – involves the ascending aorta and/or aortic arch, and possibly the descending aorta. The tear can originate in the ascending aorta, the aortic arch, or more rarely, in the descending aorta.
- B – involves the descending aorta or the arch (distal to the left subclavian artery), without the involvement of the ascending aorta.
The Stanford classification is more useful than the older DeBakey system as it follows clinical practice, as type A ascending aortic dissections generally require primary surgical treatment, whereas type B dissections can initially be treated conservatively.
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ 1.0 1.1 von Kodolitsch, Yskert; Schwartz, Ann G.; Nienaber, Christoph A. (2000). "Clinical Prediction of Acute Aortic Dissection ". Archives of Internal Medicine 160 (19): 2977. doi:. ISSN 0003-9926.
- ↑ 2.0 2.1 2.2 James H Black, III, Warren J Manning. Clinical features and diagnosis of acute aortic dissection. UpToDate. This topic last updated: Feb 16, 2018. Topic 8190 Version 29.0}}
- ↑ "Management of acute aortic dissections ". Ann Thorac Surg. 10 (3): 237–47. Sep 1970. doi:. PMID 5458238.
