Aortic Dissection (Spontaneous)
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Population Covered By The Guidance
This pathway provides guidance for imaging adult patients with suspected non-traumatic aortic dissection.
Date reviewed: July 2018
Date of next review: April 2023
Published: March 2019
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1 |  |
Aortic Dissection - Type A Image 1 (CT Angiography): Stanford type A Aortic Dissection involving the ascending and descending thoracic aorta (arrows). |
Teaching Points
Teaching Points
- CTA is the investigation of choice to evaluate suspected aortic dissection
- A chest radiograph is useful in excluding other causes of chest pain and can be performed if readily available, but it should not delay obtaining a CT. A normal chest radiograph does not exclude aortic dissection and further imaging should still be pursued
- TOE provides immediate information with comparable accuracy to CTA and can be useful in haemodynamically unstable patients if an experienced operator is readily available. TOE does not visualise the distal extension of a descending dissection
- MRI/MRA also has high diagnostic accuracy and does not require iodinated contrast so can be considered for haemodynamically stable patients in whom contrast is contraindicated. Long examination times and limited availability can potentially delay diagnosis so MRI is not widely used
- Stanford classification of aortic dissection:
- Type A dissection includes the ascending aorta
- Type B dissection does not involve the ascending aorta (i.e. distal to left subclavian artery)
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- American College of Radiology. ACR appropriateness criteria. Acute chest pain - suspected aortic dissection. (Guideline).View the reference
- McMahon MA, Squirrell CA. Multidetector CT of aortic dissection: a pictorial review. Radiographics. 2010;30(2):445-60. (Review article).View the reference
- Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287(17):2262-72. (Review article). View the reference
- Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-926. (Guideline). View the reference
- Moore AG, Eagle KA, Bruckman D, Moon BS, Malouf JF, Fattori R, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol. 2002;89(10):1235-8. (Level III evidence). View the reference
- Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166(13):1350-6. (Level I-II evidence). View the reference
- LePage MA, Quint LE, Sonnad SS, Deeb GM, Williams DM Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol. 2001;177(1):207-11. (Level III evidence). View the reference
- Thoongsuwan N, Stern EJ. Chest CT scanning for clinical suspected thoracic aortic dissection: beware the alternate diagnosis. Emergency radiology. 2002;9(5):257-61. (Level II evidence). View the reference
- Sommer T, Fehske W, Holzknecht N, Smekal AV, Keller E, Lutterbey G, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology. 1996;199(2):347-52. (Level II-III evidence). View the reference
- Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328(1):1-9. (Level II evidence). View the reference
- Keren A, Kim CB, Hu BS, Eyngorina I, Billingham ME, Mitchell RS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol. 1996;28(3):627-36. (Level II evidence). View the reference
- Meredith EL, Masani ND. Echocardiography in the emergency assessment of acute aortic syndromes. Eur J Echocardiogr. 2009;10(1):i31-9. (Review article). View the reference
- Clough RE, Hussain T, Uribe S, Greil GF, Razavi R, Taylor PR, et al. A new method for quantification of false lumen thrombosis in aortic dissection using magnetic resonance imaging and a blood pool contrast agent. J Vasc Surg. 2011;54(5):1251-8. (Level III evidence). View the reference
- Clough RE, Waltham M, Giese D, Taylor PR, Schaeffter T. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg. 2012;55(4):914-23. (Level III evidence). View the reference
- Mintz GS, Kotler MN, Segal BL, Parry WR. Two dimensional echocardiographic recognition of the descending thoracic aorta. Am J Cardiol. 1979;44(2):232-8. (Level III evidence). View the reference
- Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller FA, Jr., Stanson AW, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. J Am Soc Echocardiogr. 1989;2(1):17-24. (Level II-III evidence). View the reference
- Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography. Eur Heart J. 1984;5(7):545-55. (Level IIII evidence). View the reference
- Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients With thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. 2010;121(13):e266-e369. (Guideline). View the reference
- Fukui T. Management of acute aortic dissection and thoracic aortic rupture. Journal of Intensive Care. 2018;6:15. (Review article). View the reference
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Magnetic Resonance Imaging (MRI) |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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