Thoracic aortic dissection

Extract Essentials Introduction An acute aortic syndrome should be considered, even if only briefly, in the differential diagnosis of any patient complaining of acute chest pain and other symptoms (Box 16.14.1.1). A careful history and physical examination will often secure the diagnosis, which is then confirmed by appropriate noninvasive investigations. The consequences of missing an acute aortic syndrome can be disastrous: when managing a patient with acute chest pain it is always prudent for clinicians to ask themselves ‘could this be an acute aortic syndrome?’ to ensure it features in the differential diagnosis before any antiplatelet or anticoagulant agents are administered. Symptoms that warrant consideration of an acute aortic syndrome The three mechanisms of acute aortic syndromes are acute aortic dissection, acute intramural haematoma, and penetrating ulcer of the aortic wall (Fig. 16.14.1.1 Sensitivity and specificity of investigations for the diagnosis of aortic dissection Pathogenesis The aortic wall is composed of three layers: a thin...