Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Clinical features and diagnosis of acute aortic dissection

James H Black, III, MD
Warren J Manning, MD
Section Editors
James Hoekstra, MD
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Aortic dissection is relatively uncommon, but it often presents acutely as a catastrophic illness with severe chest pain and acute hemodynamic compromise. Early and accurate diagnosis and treatment are crucial for survival.

Death from aortic dissection can be related to rupture of the dissection into the pericardium precipitating cardiac tamponade, acute dissection into the aortic valvular annulus leading to severe aortic regurgitation, obstruction of the coronary artery ostia leading to myocardial infarction, and end-organ failure due to abdominal aortic branch vessel obstruction [1,2]. The International Registry of Acute Aortic Dissection (IRAD) has provided a contemporary perspective from the worldwide accrual of patients into a prospective database and allowed assessment of treatment paradigms. Despite the advances detailed in their reports, mortality related to aortic dissection remains high at 25 to 30 percent [3].

The clinical manifestations and diagnosis of acute aortic dissection will be reviewed here. Medical and surgical management are discussed separately. (See "Management of acute aortic dissection" and "Surgical and endovascular management of type B aortic dissection".)


Aortic dissection is classified, somewhat arbitrarily, as acute or chronic based upon the duration of symptoms at the time of presentation. During the first two weeks (acute phase), life-threatening complications due to branch involvement or aortic rupture are more likely to occur compared with the timeframe past two weeks (chronic phase) [4,5].

Anatomic classification — The two main anatomic classifications used to describe aortic dissection are the DeBakey and Stanford (Daily) systems (figure 1) [6-9]. The Stanford system is more widely used and classifies dissections that involve the ascending aorta as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. By comparison, the DeBakey system is based upon the site of origin, with type 1 originating in the ascending aorta and propagating to at least the aortic arch, type 2 originating in and confined to the ascending aorta, and type 3 originating in the descending aorta and extending distally or proximally. An alternative classification has been proposed; the DISSECT system assesses six characteristics of dissection that provide the most important details influencing the choice of treatment, particularly those that are important when considering an endovascular procedure [10].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Nov 07, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Cambria RP. Surgical treatment of complicated distal aortic dissection. Semin Vasc Surg 2002; 15:97.
  2. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type a aortic dissection. Circulation 2002; 105:200.
  3. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283:897.
  4. Atkins MD Jr, Black JH 3rd, Cambria RP. Aortic dissection: perspectives in the era of stent-graft repair. J Vasc Surg 2006; 43 Suppl A:30A.
  5. Crawford ES. The diagnosis and management of aortic dissection. JAMA 1990; 264:2537.
  6. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003; 108:628.
  7. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation 2005; 112:3802.
  9. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg 1970; 10:237.
  10. Dake MD, Thompson M, van Sambeek M, et al. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg 2013; 46:175.
  11. Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53:849.
  12. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003; 108:772.
  13. Iwasaki H, Shibuya T, Shintani T, et al. Abdominal aortic grafting for spontaneous infrarenal abdominal aortic dissection. Ann Vasc Surg 2010; 24:255.e13.
  14. Farber A, Wagner WH, Cossman DV, et al. Isolated dissection of the abdominal aorta: clinical presentation and therapeutic options. J Vasc Surg 2002; 36:205.
  15. Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation 2004; 109:3014.
  16. Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation 1999; 99:1331.
  17. HIRST AE Jr, JOHNS VJ Jr, KIME SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37:217.
  18. Wheat MW Jr. Acute dissection of the aorta. Cardiovasc Clin 1987; 17:241.
  19. Barnes DM, Williams DM, Daska NL, et al. Renal malperfusion following aortic dissection. In: Vascular Surgery: Therapeutic Strategies, Eskandari MK, Morasch MD, Pearce WH, and Yao JST (Eds), People's Medical Publishing House, Shelton 2010.
  20. Williams DM, LePage MA, Lee DY. The dissected aorta: part I. Early anatomic changes in an in vitro model. Radiology 1997; 203:23.
  21. Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology 1997; 203:37.
  22. Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7:199.
  23. Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001; 33:1185.
  24. DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 1982; 92:1118.
  25. Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995; 92:II113.
  26. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982; 92:1103.
  27. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117:1271.
  28. Clouse WD, Hallett JW Jr, Schaff HV, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc 2004; 79:176.
  29. Melvinsdottir IH, Lund SH, Agnarsson BA, et al. The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study. Eur J Cardiothorac Surg 2016; 50:1111.
  30. Siddiqi HK, Luminais SN, Montgomery D, et al. Chronobiology of Acute Aortic Dissection in the Marfan Syndrome (from the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions and the International Registry of Acute Aortic Dissection). Am J Cardiol 2017; 119:785.
  31. Takagi H, Ando T, Umemoto T, (ALICE [All-Literature Investigation of Cardiovascular Evidence] Group). Meta-Analysis of Seasonal Incidence of Aortic Dissection. Am J Cardiol 2017; 120:700.
  32. Spittell PC, Spittell JA Jr, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68:642.
  33. LeMaire SA, Russell L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol 2011; 8:103.
  34. Isselbacher EM. Trends in thoracic aortic aneurysms and dissection: out of the shadows and into the light. Circulation 2014; 130:2267.
  35. Mehta RH, O'Gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002; 40:685.
  36. Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 2004; 43:665.
  37. Chou AS, Ma WG, Mok SC, et al. Do Familial Aortic Dissections Tend to Occur at the Same Age? Ann Thorac Surg 2017; 103:546.
  38. Hiratzka LF, Bakris GL, Beckman JA, 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. Circulation 2010; 121:e266.
  39. Erbel R, Aboyans V, Boileau C, et al. Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 2015; 36:2779.
  40. Weinsaft JW, Devereux RB, Preiss LR, et al. Aortic Dissection in Patients With Genetically Mediated Aneurysms: Incidence and Predictors in the GenTAC Registry. J Am Coll Cardiol 2016; 67:2744.
  41. Landenhed M, Engström G, Gottsäter A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc 2015; 4:e001513.
  42. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 2013; 127:2031.
  43. Pape LA, Awais M, Woznicki EM, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015; 66:350.
  44. Hsue PY, Salinas CL, Bolger AF, et al. Acute aortic dissection related to crack cocaine. Circulation 2002; 105:1592.
  45. Elefteriades JA, Hatzaras I, Tranquilli MA, et al. Weight lifting and rupture of silent aortic aneurysms. JAMA 2003; 290:2803.
  46. Jonjev ZS, Bala G. High-energy drinks may provoke aortic dissection. Coll Antropol 2013; 37 Suppl 2:227.
  47. Garnier P, Michel D, Barral FG, et al. [Roles of arterial dysplasia, chronic ergotism and other factors in a case multiple spontaneous arterial dissections]. Rev Med Interne 2000; 21:701.
  48. Ayarragaray JE. Ergotism: a change of persepective. Ann Vasc Surg 2014; 28:265.
  49. Elkayam U, Ostrzega E, Shotan A, Mehra A. Cardiovascular problems in pregnant women with the Marfan syndrome. Ann Intern Med 1995; 123:117.
  50. Roberts CS, Roberts WC. Dissection of the aorta associated with congenital malformation of the aortic valve. J Am Coll Cardiol 1991; 17:712.
  51. Nistri S, Sorbo MD, Marin M, et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 1999; 82:19.
  52. Hahn RT, Roman MJ, Mogtader AH, Devereux RB. Association of aortic dilation with regurgitant, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 1992; 19:283.
  53. Khandheria BK, Tajik AJ, Taylor CL, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. J Am Soc Echocardiogr 1989; 2:17.
  54. Blanchard DG, Kimura BJ, Dittrich HC, DeMaria AN. Transesophageal echocardiography of the aorta. JAMA 1994; 272:546.
  55. Núñez-Gil IJ, Bautista D, Cerrato E, et al. Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures. Circulation 2015; 131:2114.
  56. Januzzi JL, Sabatine MS, Eagle KA, et al. Iatrogenic aortic dissection. Am J Cardiol 2002; 89:623.
  57. Nicholson WJ, Crawley IS, Logue RB, et al. Aortic root dissection complicating coronary bypass surgery. Am J Cardiol 1978; 41:103.
  58. Hagl C, Ergin MA, Galla JD, et al. Delayed chronic type A dissection following CABG: implications for evolving techniques of revascularization. J Card Surg 2000; 15:362.
  59. Chavanon O, Carrier M, Cartier R, et al. Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery? Ann Thorac Surg 2001; 71:117.
  60. De Smet JM, Stefanidis C. Acute aortic dissection after off-pump coronary artery surgery. Eur J Cardiothorac Surg 2003; 24:315.
  61. Lin AE, Lippe B, Rosenfeld RG. Further delineation of aortic dilation, dissection, and rupture in patients with Turner syndrome. Pediatrics 1998; 102:e12.
  62. Carlson M, Airhart N, Lopez L, Silberbach M. Moderate aortic enlargement and bicuspid aortic valve are associated with aortic dissection in Turner syndrome: report of the international turner syndrome aortic dissection registry. Circulation 2012; 126:2220.
  63. Barison A, Nugara C, Barletta V, et al. Asymptomatic Takayasu Aortitis Complicated by Type B Dissection. Circulation 2015; 132:e254.
  64. Khalife T, Alsac JM, Lambert M, et al. Diagnosis and surgical treatment of a Takayasu disease on an abdominal aortic dissection. Ann Vasc Surg 2011; 25:556.e1.
  65. Smith MD, Cassidy JM, Souther S, et al. Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med 1995; 332:356.
  66. Roman MJ, Pugh NL, Hendershot TP, et al. Aortic Complications Associated With Pregnancy in Marfan Syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc 2016; 5.
  67. Kamel H, Roman MJ, Pitcher A, Devereux RB. Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis. Circulation 2016; 134:527.
  68. Thalmann M, Sodeck GH, Domanovits H, et al. Acute type A aortic dissection and pregnancy: a population-based study. Eur J Cardiothorac Surg 2011; 39:e159.
  69. Yuan SM. Postpartum aortic dissection. Taiwan J Obstet Gynecol 2013; 52:318.
  70. Kuperstein R, Cahan T, Yoeli-Ullman R, et al. Risk of Aortic Dissection in Pregnant Patients With the Marfan Syndrome. Am J Cardiol 2017; 119:132.
  71. Takagi H, Ando T, Umemoto T, (All-Literature Investigation of Cardiovascular Evidence [ALICE] Group). Meta-Analysis of Circadian Variation in the Onset of Acute Aortic Dissection. Am J Cardiol 2017; 120:1662.
  72. Kojima S, Sumiyoshi M, Nakata Y, Daida H. Triggers and circadian distribution of the onset of acute aortic dissection. Circ J 2002; 66:232.
  73. Park SW, Hutchison S, Mehta RH, et al. Association of painless acute aortic dissection with increased mortality. Mayo Clin Proc 2004; 79:1252.
  74. Gaul C, Dietrich W, Friedrich I, et al. Neurological symptoms in type A aortic dissections. Stroke 2007; 38:292.
  75. Januzzi JL, Movsowitz HD, Choi J, et al. Significance of recurrent pain in acute type B aortic dissection. Am J Cardiol 2001; 87:930.
  76. Trimarchi S, Eagle KA, Nienaber CA, et al. Importance of refractory pain and hypertension in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2010; 122:1283.
  77. Jarvis S, Donohoe P, Huang D, Macdougall IC. Unusual presentation of aortic dissection with bilateral testicular pain and rapidly deteriorating renal function. Urology 2014; 83:989.
  78. van de Wal-Visscher E, Nieuwenhuijzen GA, van Sambeek MR, et al. Type B aortic dissection resulting in acute esophageal necrosis. Ann Vasc Surg 2011; 25:837.e1.
  79. Ravichandran P, Harrington DM, Lovell MB, et al. Patterns of visceral and renal artery involvement in type B aortic dissections. Vasc Endovascular Surg 2013; 47:5.
  80. Bossone E, Rampoldi V, Nienaber CA, et al. Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol 2002; 89:851.
  81. Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003; 108 Suppl 1:II312.
  82. Nallamothu BK, Mehta RH, Saint S, et al. Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications. Am J Med 2002; 113:468.
  83. Movsowitz HD, Levine RA, Hilgenberg AD, Isselbacher EM. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol 2000; 36:884.
  84. Aktas C, Cinar O, Ay D, et al. Acute aortic dissection with painless paraplegia: report of 2 cases. Am J Emerg Med 2008; 26:631.e3.
  85. Bossone, E, et al. Coronary artery involvement in patients with acute type A aortic dissection: Clinical characteristics and in-hospital outcomes. J Am Coll Card 2003; 41S:235.
  86. von Kodolitsch Y, Nienaber CA, Dieckmann C, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med 2004; 116:73.
  87. Suzuki T, Distante A, Zizza A, et al. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation 2009; 119:2702.
  88. Shimony A, Filion KB, Mottillo S, et al. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am J Cardiol 2011; 107:1227.
  89. Paparella D, Malvindi PG, Scrascia G, et al. D-dimers are not always elevated in patients with acute aortic dissection. J Cardiovasc Med (Hagerstown) 2009; 10:212.
  90. Asha SE, Miers JW. A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection. Ann Emerg Med 2015; 66:368.
  91. Sbarouni E, Georgiadou P, Marathias A, et al. D-dimer and BNP levels in acute aortic dissection. Int J Cardiol 2007; 122:170.
  92. Wiegand J, Koller M, Bingisser R. Does a negative D-dimer test rule out aortic dissection? Swiss Med Wkly 2007; 137:462.
  93. Ohlmann P, Faure A, Morel O, et al. Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Crit Care Med 2006; 34:1358.
  94. Hazui H, Fukumoto H, Negoro N, et al. Simple and useful tests for discriminating between acute aortic dissection of the ascending aorta and acute myocardial infarction in the emergency setting. Circ J 2005; 69:677.
  95. Akutsu K, Sato N, Yamamoto T, et al. A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection. Circ J 2005; 69:397.
  96. Eggebrecht H, Naber CK, Bruch C, et al. Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol 2004; 44:804.
  97. Weber T, Högler S, Auer J, et al. D-dimer in acute aortic dissection. Chest 2003; 123:1375.
  98. Marill KA. Serum D-dimer is a sensitive test for the detection of acute aortic dissection: a pooled meta-analysis. J Emerg Med 2008; 34:367.
  99. Akutsu K, Yamanaka H, Katayama M, et al. Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection. Am J Cardiol 2016; 118:1405.
  100. Suzuki T, Katoh H, Watanabe M, et al. Novel biochemical diagnostic method for aortic dissection. Results of a prospective study using an immunoassay of smooth muscle myosin heavy chain. Circulation 1996; 93:1244.
  101. Suzuki T, Katoh H, Tsuchio Y, et al. Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study. Ann Intern Med 2000; 133:537.
  102. Marshall LM, Carlson EJ, O'Malley J, et al. Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation. Circ Res 2013; 113:1159.
  103. Rogers AM, Hermann LK, Booher AM, 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. Circulation 2011; 123:2213.
  104. Sattiraju S, Missov E. Delayed presentation of acute aortic syndrome. Lancet 2014; 383:2238.
  105. Harris KM, Strauss CE, Eagle KA, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation 2011; 124:1911.
  106. Kimura N, Ohnuma T, Itoh S, et al. Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol 2014; 113:724.
  107. von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000; 160:2977.
  108. Crawford TC, Beaulieu RJ, Ehlert BA, et al. Malperfusion syndromes in aortic dissections. Vasc Med 2016; 21:264.
  109. Kienzl D, Prosch H, Töpker M, Herold C. Imaging of non-cardiac, non-traumatic causes of acute chest pain. Eur J Radiol 2012; 81:3669.
  110. Sueyoshi E, Nagayama H, Hayashida T, et al. Comparison of outcome in aortic dissection with single false lumen versus multiple false lumens: CT assessment. Radiology 2013; 267:368.
  111. Moon MC, Greenberg RK, Morales JP, et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg 2011; 53:942.
  112. Jaussaud N, Chitsaz S, Meadows A, et al. Acute type A aortic dissection intimal tears by 64-slice computed tomography: a role for endovascular stent-grafting? J Cardiovasc Surg (Torino) 2013; 54:373.
  113. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med 1993; 328:35.
  114. Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1.
  115. Moore AG, Eagle KA, Bruckman D, 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; 89:1235.
  116. Hartnell G, Costello P. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1637; author reply 1638.
  117. Evangelista A, Garcia-del-Castillo H, Gonzalez-Alujas T, et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts. J Am Coll Cardiol 1996; 27:102.
  118. Roudaut RP, Billes MA, Gosse P, et al. Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases. Clin Cardiol 1988; 11:553.
  119. Erbel R, Engberding R, Daniel W, et al. Echocardiography in diagnosis of aortic dissection. Lancet 1989; 1:457.
  120. LePage MA, Quint LE, Sonnad SS, et al. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol 2001; 177:207.
  121. Sommer T, Fehske W, Holzknecht N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996; 199:347.
  122. Sebastià C, Pallisa E, Quiroga S, et al. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 1999; 19:45.
  123. Hamada S, Takamiya M, Kimura K, et al. Type A aortic dissection: evaluation with ultrafast CT. Radiology 1992; 183:155.
  124. Hayter RG, Rhea JT, Small A, et al. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology 2006; 238:841.
  125. Loubeyre P, Angelie E, Grozel F, et al. Spiral CT artifact that simulates aortic dissection: image reconstruction with use of 180 degrees and 360 degrees linear-interpolation algorithms. Radiology 1997; 205:153.
  126. Schertler T, Glücker T, Wildermuth S, et al. Comparison of retrospectively ECG-gated and nongated MDCT of the chest in an emergency setting regarding workflow, image quality, and diagnostic certainty. Emerg Radiol 2005; 12:19.
  127. Freeman LA, Young PM, Foley TA, et al. CT and MRI assessment of the aortic root and ascending aorta. AJR Am J Roentgenol 2013; 200:W581.
  128. Vasile N, Mathieu D, Keita K, et al. Computed tomography of thoracic aortic dissection: accuracy and pitfalls. J Comput Assist Tomogr 1986; 10:211.
  129. Clough RE, Waltham M, Giese D, et al. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg 2012; 55:914.
  130. Gebker R, Gomaa O, Schnackenburg B, et al. Comparison of different MRI techniques for the assessment of thoracic aortic pathology: 3D contrast enhanced MR angiography, turbo spin echo and balanced steady state free precession. Int J Cardiovasc Imaging 2007; 23:747.
  131. Penn MS, Smedira N, Lytle B, Brener SJ. Does coronary angiography before emergency aortic surgery affect in-hospital mortality? J Am Coll Cardiol 2000; 35:889.
  132. Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection. Improved survival with less angiography. J Thorac Cardiovasc Surg 1994; 108:567.
  133. Bansal RC, Chandrasekaran K, Ayala K, Smith DC. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol 1995; 25:1393.
  134. White RD, Lipton MJ, Higgins CB, et al. Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography. Am J Cardiol 1986; 57:282.
  135. Shuford WH, Sybers RG, Weens HS. Problems in the aortographic diagnosis of dissecting aneurysm of the aorta. N Engl J Med 1969; 280:225.
  136. Earnest F 4th, Muhm JR, Sheedy PF 2nd. Roentgenographic findings in thoracic aortic dissection. Mayo Clin Proc 1979; 54:43.
  137. Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J 2001; 22:1642.
  138. Steuer J, Björck M, Mayer D, et al. Distinction between acute and chronic type B aortic dissection: is there a sub-acute phase? Eur J Vasc Endovasc Surg 2013; 45:627.
  139. Pacifico L, Spodick D. ILEAD--ischemia of the lower extremities due to aortic dissection: the isolated presentation. Clin Cardiol 1999; 22:353.
Topic Outline