Aortic dissection

Typical patient
• Middle-aged or elderly patient with a history of hypertension or arteriosclerotic disease
• Occasionally younger patient with aortic root disease (e.g. Marfan's syndrome)

Major symptoms
• Chest pain

Major signs
• Often none
• Sometimes regional arterial insufficiency (e.g. occlusions of coronary artery causing myocardial infarction, carotid or verterbral artery causing stroke, spinal artery causing hemi- or quadriplegia); subclavian artery occlusion may cause differential blood pressure in either arm; aortic regurgitation; cardiac tamponade; sudden death

Diagnosis
• CXR: widened mediastinum, occasionally with left pleural effusion
• Transoesophageal echocardiogram: confirms dissection
• CT scan: confirms dissection
• MRI scan: confirms dissection

Additional investigations
• None

Comments
• Having estabished the diagnosis, emergency surgery is usually necessary, particularly if the dissection involves the ascending thoracic aorta