Presentation on theme: "Aortic Dissection By Hari Bhatt. Definition Aortic dissection is an acute event where blood enters the aortic wall through a tear of the intima followed."— Presentation transcript:
Definition Aortic dissection is an acute event where blood enters the aortic wall through a tear of the intima followed by extravasation of blood into the media. Currently believed the process begins with an intramural hematoma
Classification DeBakey: I –ascending aorta --> arch +/- descending aorta II –ascending aorta only III –descending aorta --> thoracic aorta
Classification (cont.) More commonly used is the Stanford classification, better linked to clinical outcome Type A: involves the ascending aorta acute, 70% mortality Type B: not involving the ascending aorta, chronic tx. conservatively
Type B Dissection a) Increased soft tissue shadow beyond the aortic knuckle, b) one year before
Type A dissection A medical emergency Imaging may include –Chest radiograph –TOE best accuracy, in skilled hands, however more invasive –MRI- ok if pt. stable, otherwise not used in acute scenario, good at showing early intramural hematoma –CT- disadvantage restricted to single axial plane, motion artifacts of the aortic root
Which imaging study works?? In a large and well constructed study by Nienaber et. al. TOE, TTE, CT, MRI were compared in pt’s with suspected acute aortic dissection. -the results showed that for sensitivity: TOE (97.7%), TTE (59.3%), CT (93.8%), MRI (98.3%) -as for specificity: TOE (77.0%), TTE(83.0%), CT (87.1%), MRI (97.8%)
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