Aortic dissection

23 Aortic dissection



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Fig. 23.1A This radiograph demonstrates widening of the mediastinum caused by a thoracic aortic dissection.



Background


This is an important condition with a high mortality rate. Untreated mortality is 50% in the first 24 hours.


There are several causes including Marfan syndrome, Ehlers–Danlos syndrome and iatrogenic trauma.


Classification and further management depends on which parts of the aorta are affected. If the dissection commences distal to the left subclavian artery (Stanford type B), the dissection is generally treated conservatively; if it affects the ascending aortic arch (Stanford type A), operative treatment is indicated.


As these patients generally present with chest pain they can be mistakenly treated for acute coronary syndrome. A high clinical and radiological index of suspicion is required for accurate diagnosis.



Clinical features


Aortic dissection generally affects people between 40 and 70 years of age. There is a male to female ratio of 3 to 1.



Signs and symptoms


There is sudden-onset tearing chest pain radiating to the back, with the pain being worst at onset. The pain may also be interscapular.


Signs and symptoms may also reflect involvement of branches of the aorta, e.g. Horner’s syndrome (carotid), neurology (carotid), secondary myocardial infarct (coronary).


Check the blood pressure in each arm to look for a difference between the sides.

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Aortic dissection

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