2019]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":918,"mcqUrl":"https://radiopaedia.org/articles/aortic-dissection/questions/198?lang=us"}. Unable to process the form. Continued. 19 (1): 45-60. 5. (2018). Doctors often suspect an aortic dissection if the following signs and symptoms are present: 1. Emerg Radiol. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. Weissleder R, Wittenberg J, M.D. Rogers AM, Hermann LK 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. True versus false channel o False channel usually arises anterior in the ascending aorta and spirals to posterior and left lateral in descending aorta o True channel is usually larger Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). 2002;223 (1): 270-4. Multidetector CT may be performed with 1-2.5 mm collimation. Aortitis is a pathologic term for the presence of inflammatory changes of the aortic wall, regardless of the underlying cause. The upper mediastinum was widened. (2010) Radiographics : a review publication of the Radiological Society of North America, Inc. 30 (2): 445-60. doi:10.1148/rg.302095104 - Pubmed. Aortic dissection: CT features that distinguish true lumen from false lumen. 46 (2): 175-90. Complications of all types of aortic dissection include: A Stanford type A dissection may also result in: Although the combination of blood pressure control and surgical intervention has significantly lowered in-hospital mortality, it remains significant, at 10-35%. AJR Am J Roentgenol. Definitive imaging [5] Definitive imaging is used to determine the type of lumen, location, and extent of the dissecting membrane. The authors describe dissections that originate from the arch or extend proximally into the arch without the involvement of the ascending aorta which are not adequately accounted for in the Stanford nor the DeBakey classification systems. Diagnostic imaging plays a substantial role in meeting this objective in the case of thoracic aortic dissection. CT is the principal modality used to diagnose acute aortic dissection (AAD). The aortic knob was very enlarged and had displaced the trachea to the right. Signs of cardiac tamponade (Beck's triad) may also be encountered if rupture occurs into the pericardial space. 11. McMahon MA, Squirrell CA. 35 years, aortic dissection was related to pregnancy in 20 of 105 women (19%). American surgical consensus (2020) 5 defines types A and B according to the location of the intimal tear (both types with additional qualifiers for proximal and distal extent): In contrast, a European surgical consensus document (2018) 6 recognizes dissections of the arch without involvement of the ascending aorta as a distinct category, termed "non-A-non-B dissection": ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. This review focuses on the role of CT and MRI in the diagnosis, follow-up, and surgical planning of aortic aneurysms and acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer. The aortic dissection detection risk score (ADD-RS) combined with a negative D-dimer test has been demonstrated to be effective in reducing unnecessary exams, however, it has not been widely accepted into clinical practice and requires further validation 13,14. Radiology 1992; … Dissection is the most common aortic emergency, being more prevalent than thoracoabdominal aortic aneurysm rupture (Castaner et al. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. The dissection flap begins just above the level of sinotubular junction down to the level of the upper abdominal aorta to just above the level of the origin of renal arteries. Lai V, Tsang WK, Chan WC et-al. The doctor may use one or more of these: X-ray. Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry … 6. The Chest X-Ray: A Survival Guide. Emerg Med J. Among women . The aortic root at the mid aortic sinus is 5.4 cm. 18. 8. 17. The appropriate selection and timing of imaging studies is crucial. Blood pressure difference between right and left armsAlthough these signs and symptoms suggest aortic dissection, more-sensitive imaging techniques are needed. Akutsu K, Yoshino H, Tobaru T, Hagiya K, Watanabe Y, Tanaka K, Koyama N, Yamamoto T, Nagao K, Takayama M. Acute type B aortic dissection with communicating vs. non-communicating false lumen. Shu C, Wang T, Li QM, Li M, Jiang XH, Luo MY, et al. Risks of angiography include general risks of angiography plus the risk of catheterizing the false lumen and causing aortic rupture. Sudden tearing or ripping chest pain 2. 2003). The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. MG et-al. Aortic arch dissection: a controversy of classification. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. 137 (3): 250-258. Transesophageal echocardiography (TOE) has very high sensitivity and specificity for assessment of acute aortic dissection, but due to limited access and its invasive nature, it has largely been replaced by CTA (or MRA in some instances) 5. 2003;181 (2): 309-16. Lepage MA, Quint LE, Sonnad SS et-al. Lempel JK, Frazier AA, Jeudy J, Kligerman SJ, Schultz R, Ninalowo HA, Gozansky EK, Griffith B, White CS. However, treating these patients with antiplatelets/anticoagulation could be disastrous in aortic dissection. (2019) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. The diagnosis of aortic aneurysms and aortic dissection has been revolutionized by developments in cross-sectional imaging. Noninfectious aortitis occurs in large-vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. It is also seen in other collagen vascular disorders such as rheumatoid arthritis and ankylosing spondylitis. On CT, a number of entities that can mimic a dissection should be considered 5: Clinically, a number of causes of acute chest pain are often considered: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. If clinical suspicion for acute aortic dissection persists, perform a second imaging study! Ko SF, Hsieh MJ, Chen MC et-al. Primer of Diagnostic Imaging, Expert Consult- Online and Print. Clinical suspicion is usually based on mechanism and severity of the injury, the hemodynamic status of the patient and/or the presence of related injuries. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2018 Oct 31. An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Non-contrast CT may demonstrate only subtle findings; however, a high-density mural hematoma is often visible. Intraaortic balloon pump location and aortic dissection. 97. Infectious aortitis may be secondary to tuberculosis, syphilis, or infection with Salmonellaor … Chest radiography may be normal or demonstrate a number of suggestive findings, including: Depending on etiology, there may be signs of periaortic or mediastinal hematoma which include: CT, especially with arterial contrast enhancement (CTA) is the investigation of choice, able not only to diagnose and classify the dissection but also to evaluate for distal complications. Aortic dissection makes up one of the Acute Aortic Syndromes (AAS). Intraoperative transesophageal echocardiography provides incremental information to the original imaging examination in the management of type-A acute aortic dissection in nearly two-thirds of patients, leading to a change in the planned surgery in 39% of patients, thus supporting its role as sugges … Clinical presentation may include chest or mid-scapular back pain, signs of external chest trauma or hemodynamic instability. 57 (2): 165-198. 1. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 1949-1972. The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen. thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries, rupture into the pericardial sac with resulting, medical management with blood pressure control, type A: dissections with a tear in the ascending aorta including a segment with the branching of the brachiocephalic trunk, type B: all dissections with proximal tear distal to the branching of the brachiocephalic trunk, type A: proximal extent in ascending aorta, non-A-non-B dissection: retrograde extent or proximal tear in the arch between the brachiocephalic trunk and left subclavian artery, type B: proximal extent in descending aorta distal to left subclavian artery. Conventional digital subtraction angiography has historically been the gold standard investigation. Effects of heart rate on motion artifacts of the aorta on non-ECG-assisted 0.5-sec thoracic MDCT. 2012;19 (4): 309-15. McMahon MA, Squirrell CA. The signs and symptoms are non-specific and distracting injuries are often present. AJR Am J Roentgenol. Pulsation artefact can mimic dissection, is very common and seen in up to 92% of non-gated CTA studies 8. Mosby Inc. (2007) ISBN:0323040683. Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. A typical helical scanning protocol for aortic dissection includes the following parameters: 5-mm collimation, 1.5 pitch, and 7.5-mm imaging spacing. Aortic dissection ( 85-90% of AAS) – involves a tear of the intimal layer of the aorta, with the formation of a false lumen and anterograde or retrograde expansion Some cases of aortic dissection may result in rupture, causing collapse and often death. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Nazerian P, Mueller C et al. The nomenclature of these arch dissections has been incoherent for decades and still is. Traditionally investigated by contrast angiography, the last two decades have seen considerable developments in the diagnosis of aortic disease by echocardiography, CT, and MRI. The CTPA is of good quality and no pulmonary embolus is identified. Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. 21 GOV.UK. Radiology. 109 (3): 959-981. Srichai MB, Lieber ML, Lytle BW, Kasper JM, White RD. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 … Vasile N, Mathieu D, Keita K, Lellouche D, Bloch G, Cachera JP. Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients. 3. Stanford classification of aortic dissection, Stanford classification of aortic dissections. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Kazerooni EA, Bree RL, Williams DM. If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.Aortic dissection is relatively uncommon. Acute aortic dissection is readily diagnosed using CT scanning, with the reported diagnostic accuracy ranging from 88% to 100% [1,2,3]. 20. 7. Angiography still is required for endoluminal repair. 1 Aortic dissection and aortic aneurysm surgery: Clinical observations, experimental investigations, and statistical analyses part III 1986; 10: 211 – 215. 12. A variety of imaging modalities are available in the emergency department, though CT angiography is the most widely used definitive study for this condition. Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. Findings include 1-3,5: An essential part of the assessment of aortic dissection is identifying the true lumen, as the placement of an endoluminal stent-graft in the false lumen can have dire consequences. In most cases the vessel wall is abnormal. Dissections involving the aortic root should ideally be assessed with ECG-gated CTA which nearly totally eliminates pulsation artefact. Asian Cardiovasc Thorac Ann . 2003): 75 % of deaths from aortic dissection occur within 2 weeks of clinical presentation. Follow-up brain imaging confirmed multiple ischaemic stroke in bilateral hemispheres. In such instances, a number of features are helpful 3: Chronic dissection flaps are often thicker and straighter than those seen in acute dissections 3. Emergency Medicine Journal 2001;18:183-185. 15. Two classification systems are in common usage, both of which divide dissections according to the involvement of the ascending aorta: In recent years, the Stanford classification has gained favor with cardiothoracic surgeons. Along with the DeBakey classification, the Stanford classification 7 is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. A total of 29 women (mean [standard deviation (SD)] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. Macura KJ, Corl FM, Fishman EK et-al. Acute dissection of the descending aorta: noncommunicating versus communicating forms. (1970) The Annals of thoracic surgery. 7. 1991; 180: 297 – 305. Widening of the aorta on chest X-ray 3. 16. 5. AJR Am J Roentgenol. It has similar sensitivity and specificity to CTA and TOE 5 but suffers from limited availability and the difficulties inherent in performing MRI on acutely unwell patients. One option to repair an aortic dissection is for an Interventional Radiologist to perform an aortic fenestration procedure. Causes include: Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification (which dictates management). Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. 3 4. J Comput Assist Tomogr. Approximately 80% of patients with thoracic aorticinjury die at the scene of the trauma. Mosby. (2015) Circulation journal : official journal of the Japanese Circulation Society. [online] Available at: https://www.gov.uk/drug-safety-update/systemic-and-inhaled-fluoroquinolones-small-increased-risk-of-aortic-aneurysm-and-dissection-advice-for-prescribing-in-high-risk-patients [Accessed 22 Jun. Acute thoracic dissection is life-threatening and requires immediate diagnosis and treatment (Castaner et al. MR imaging showed a marginal high-intensity area along the aortic wall, while CT showed a nonopacified crescentic area along the aortic … Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. A new classification system was proposed which is referred with the acronym DISSECT (duration, intimal tear, size of the dissected aorta, the segmental extent of involvement, clinical complications, and thrombosis of the false lumen) 18. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. It also provides a systematic approach to the definition, causes, natural history, and imaging principles of these diseases. Contrast-enhanced CT (preferably CTA) gives excellent detail. Acute Aortic Syndromes. (2018) BMJ (Clinical research ed.). 13. Hurwitz LM, Goodman PC. Radiographics. Over the 10 years following diagnosis another 15-30% of patients require surgery for life-threatening complications 5. 2001;177 (1): 207-11. 6. Gleeson CE, Spedding RL, Harding LA, et al The mediastinum—Is it wide? 360: k678. 328, No. Fourteen patients with aortic dissection without intimal rupture were examined by means of magnetic resonance (MR) imaging, computed tomography (CT), or both. 2009;192 (5): W222-9. Abstract The classic entity of life-threatening aortic dissection represents one pathology of a spectrum of acute conditions coined the acute aortic syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained aortic rupture of any cause. The Stanford classification divides dissections by the most proximal involvement: A special case that is neither reflected in the original Stanford nor the DeBakey classification are dissections that involve the aortic arch but not the ascending aorta (between 8 and 15% of all aortic dissections 4). (2011) Circulation. 4. true FISP) may see MRI having a larger role to play in the acute diagnosis, particularly in patients with impaired renal function 4. Findings: There was a left, apical, pleural cap. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. Diagnostic Imaging in the Evaluation of Suspected Aortic Dissection -- Old Standards and New Directions New England Journal of Medicine, Vol. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. Radiology. The condition most frequently occurs in men in their 60s and 70s… Th… Type A dissection typically requires urgent surgical intervention, whereas type B dissection can often be treated medically. Unable to process the form. Check for errors and try again. Blount KJ, Hagspiel KD. Age-related presentation of acute type A aortic dissection. You’ll need imaging tests to make sure you have an aortic dissection. 2. This treatment uses a catheter (tube) to … CCT has emerged as the initial diagnostic modality to identify or exclude AAD by virtue of: Imaging both the thoracic and abdominal aorta (vs. echocardiography), which … Distinguishing between the two is often straightforward, but in some instances, no clear continuation of one lumen with normal artery can be identified. Approximately 60% of dissections involve the ascending aorta (Stanford A or DeBakey I and II) 5. Aortic wall inflammation may be infectious or more commonly noninfectious. 19. Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Document Reviewers, Chakfe N, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt JS, Ma WG, Suwalski P, Vermassen F, Wahba A, Wyler von Ballmoos MC. (2014) Radiology. Saunders Ltd. ISBN:0702030465. Pre-emptive surgical intervention is currently reserved for patients with severe aortic dilatation, although abundant evidence describes the occurrence of dissection and rupture in aortas with diameters below surgical thresholds. Aortic dissection can be rapidly fatal, with many patients dying before presentation to the emergency department (ED) or before diagnosis is made in the ED.No one sign or symptom can positively identify AJR Am J Roentgenol. Immediate CT angiography chest: Type 1 aortic dissection with extension into the brachiocephalic artery and right common carotid artery (RCCA) with thrombosis in RCCA. 79 (3): 567-73. 218492318810087. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. In those who make it to hospital, clinical diagnosis is difficult. Depending on the extent of dissection and occlusion of aortic branches, end-organ ischemia may also be present (seen in up to 27% of cases) 5, including: If the aortic dissection involves the aortic root it may result in involvement of the coronary arteries and can present similarly to ST-elevation myocardial infarction on an ECG. Lombardi JV, Hughes GC, Appoo JJ, Bavaria JE, Beck AW, Cambria RP, Charlton-Ouw K, Eslami MH, Kim KM, Leshnower BG, Maldonado T, Reece TB, Wang GJ. Aortic diameter, true lumen, and false lumen growth rates in chronic type B aortic dissection. AJR Am J Roentgenol. The majority of aortic dissections are seen in elderly hypertensive patients. Case 7: Stanford type A with rupture into pericardium, Case 8: dissection confined to the infrarenal aorta, Case 10: Stanford type B dissecting aneurysm, Case 22: Stanford type A : background Marfan syndrome, Case 25: ruptured Stanford type A aortic dissection, aortic dissection detection risk score (ADD-RS), thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries, ciprofloxacin use (unclear if class effect for fluoroquinolone agents), fluoroquinolones seem to promote loss of extracellular matrix integrity, by several mechanisms, in the UK caution is now advised in using these agents in high-risk patients, acute: within 14 days of first symptom onset, chronic: more than 3 months from the initial onset of symptoms, inherited connective tissue disorders (pathogenesis: medial degeneration), widened mediastinum: > 8.0-8.8 cm at the level of the, inward displacement of atherosclerotic calcification (>1 cm from the aortic margin), left main bronchus inferiorly (decreased angle from the horizontal), increased thickness of the left and/or right paratracheal stripe, an atypical variant that may be seen is an, involvement and supply (from true or false lumen) of aortic branches, signs of organ ischemia or vessel occlusion, often compressed by the false lumen and the smaller of the two, outer wall calcifications (helpful in acute dissections), origin of the celiac trunk, SMA and right renal artery usually arise  from the true lumen, often larger lumen size due to higher false luminal pressures, at risk for rupture due to reduced elastic recoil and dilation, often of lower contrast density due to delayed opacification, maybe thrombosed and seen as mural low density only (more common in chronic dissections), the left renal artery usually arises from the false lumen, aggressive blood pressure control with beta-blockers as they reduce both blood pressure and also heart rate hence reduce extra pressure on the aortic wall, immediate surgical repair (for type A dissection or complicated type B dissection), dissection and occlusion of branch vessels, aneurysmal dilatation: this is an indication for endovascular or surgical intervention, rupture into the pericardial sac with resulting. Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health problems. (2020) The Annals of thoracic surgery. Computed tomography of thoracic aortic dissection: accuracy and pitfalls. Multidetector CT of Aortic Dissection: A Pictorial Review. 19 (1): 45-60. There may be a difference in blood pressure between the two arms depending on where the dissection occurs. Sebastià C, Pallisa E, Quiroga S et-al. 14. 2010;30 (2): 445-60. Aortic Dissection . 2. Clinically these conditions are indistinguishable. 271 (3): 848-55. Type A aortic dissection involves the ascending thoracic aorta and may extend into the descending aorta, whereas in a type B dissection the intimal tear is located distal to the left subclavian artery. Figure 8.5 Contrast enhanced Computed Tomography of the Chest, Abdomen and Pelvis, intimal flap seen associated with aortic dissection. In a very small minority, an underlying connective tissue disorder may be present. Sebastià C, Pallisa E, Quiroga S et-al. Check for errors and try again. On finding extensive descending aortic dissection extending into the abdominal aorta and left common carotid artery, further CTA was performed of the neck, abdomen and pelvis as well as a ECG-gated CTA of the aortic root. 77 (6): 2012-20; discussion 2020. It has reported sensitivity and specificity of nearly 100% 3,5. 4. The radiologic assessment of patients suspected of having an aortic dissection must be based on an understanding of the treatment options and how these are to be employed in any clinical setting. (2011) ISBN:0323065384. 2007;24 (4): 310. There have been efforts to construct a clinical decision rule stratify risk of acute aortic dissection and avoid over-investigation. [Medline] . Although in general MRA has been reserved for follow-up examinations, rapid non-contrast imaging techniques (e.g. Thoracic aortic dissection and aneurysm: evaluation with nonenhanced true FISP MR angiography in less than 4 minutes. The differential on chest x-ray is that of a dilated thoracic aorta. Malvindi PG, Votano D, Ashoub A, et al. Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. The 3 diagnoses are considered as part of the same spectrum of disease and are investigated and treated similarly. 10. (2013) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2005;184 (4): 1225-30. 123 (20): 2213-8. Acute aortic syndromes comprise a group of potentially fatal conditions that result from weakening of the aortic vessel wall. Displacement of atherosclerotic calcification into the lumen is also a frequently identified finding. Dissection flap extending from the aortic root down to the level of the upper abdominal aorta. Oliver TB, Murchison JT, Reid JH. Management of acute aortic dissections. Pereles FS, Mccarthy RM, Baskaran V et-al. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. The term Acute Aortic Syndrome (AAS) is used to describe three closely related emergency entities of the thoracic aorta: classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU). (2018) Circulation. 9. de Lacey G, Morley S et-al. In 2014, a special report was published in Radiology 4 that recognized an uncommon form of aortic dissection. Examples include 5: The duration of aortic dissection is arbitrarily categorized into three phases 18,19: Patients are often hypertensive (although they may be normotensive or hypotensive) and present with anterior or posterior chest pain and a tearing sensation in the chest. 10 (3): 237-47. 3. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). 2005;184 (4): 1245-6. No signs of right ventricular strain. Petasnick JP, Radiologic evaluation of aortic dissection. 1. Aortic dissection is may sometimes be classified as communicating versus non-communicating 16,17. Imaging Assessment Chest x-ray. Also, vomiting, sweating, and lightheadedness may occur. Other conditions or predisposing factors may also be encountered, in which case they will be reflected in the demographics. Tests to make sure you have an aortic dissection and avoid over-investigation thoracic aorta excellent detail ] imaging! 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