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Vasculature
Diagnosis
Arterial
Thoracic Aorta and Great Vessels
Aortic Dissection
Aortic Dissection
Suhny Abbara, MD, FACR, FSCCT; Naveen M. Kulkarni, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Aortic dissection (AoD)

            • Definitions

              • Blood enters media of aortic wall through intimal defect and splits wall longitudinally
              • Stanford classification
                • Type A (60%): Involves ascending aorta, ± descending aorta
                  • Surgical treatment
                • Type B (40%): Excludes ascending aorta; involves descending aorta &/or aortic arch
                  • Medical management
              • DeBakey classification
                • Type I: Involves ascending aorta, aortic arch, and descending aorta
                • Type II: Involves ascending aorta
                • Type III: Involves descending aorta distal to left subclavian artery

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Echocardiographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Di Eusanio M et al: Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 145(2):385-390, 2013
                                            2. Rogers AM et al: Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation. 123(20):2213-8, 2011
                                            3. Liu Q et al: Three-dimensional contrast-enhanced MR angiography of aortic dissection: a pictorial essay. Radiographics. 27(5):1311-21, 2007
                                            4. García A et al: MR angiographic evaluation of complications in surgically treated type A aortic dissection. Radiographics. 26(4):981-92, 2006
                                            5. Bortone AS et al: Endovascular treatment of thoracic aortic disease: four years of experience. Circulation. 110(11 Suppl 1):II262-7, 2004
                                            6. Batra P et al: Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography. Radiographics. 20(2):309-20, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Aortic dissection (AoD)

                                                      • Definitions

                                                        • Blood enters media of aortic wall through intimal defect and splits wall longitudinally
                                                        • Stanford classification
                                                          • Type A (60%): Involves ascending aorta, ± descending aorta
                                                            • Surgical treatment
                                                          • Type B (40%): Excludes ascending aorta; involves descending aorta &/or aortic arch
                                                            • Medical management
                                                        • DeBakey classification
                                                          • Type I: Involves ascending aorta, aortic arch, and descending aorta
                                                          • Type II: Involves ascending aorta
                                                          • Type III: Involves descending aorta distal to left subclavian artery

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Echocardiographic Findings

                                                                • Angiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Di Eusanio M et al: Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 145(2):385-390, 2013
                                                                                      2. Rogers AM et al: Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation. 123(20):2213-8, 2011
                                                                                      3. Liu Q et al: Three-dimensional contrast-enhanced MR angiography of aortic dissection: a pictorial essay. Radiographics. 27(5):1311-21, 2007
                                                                                      4. García A et al: MR angiographic evaluation of complications in surgically treated type A aortic dissection. Radiographics. 26(4):981-92, 2006
                                                                                      5. Bortone AS et al: Endovascular treatment of thoracic aortic disease: four years of experience. Circulation. 110(11 Suppl 1):II262-7, 2004
                                                                                      6. Batra P et al: Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography. Radiographics. 20(2):309-20, 2000
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