Aortic dissection other imaging findings

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pre-operative angiography has not been associated with improved outcomes in retrospective analyses. Aortography is rarely used in the modern era. It can be used of the other imaging modalities are not available or are inconclusive.

Coronary Angiography

It is reasonable to perform coronary angiography in the following scenarios:

• Age over 60 years
• Presence of CAD risk factors
• History of prior myocardial infarction

Aortography

• The aortogram was previously considered the gold standard test for the diagnosis of aortic dissection, with a sensitivity of up to 88% and a specificity of about 94%. It is especially poor in the diagnosis of cases where the dissection is due to hemorrhage within the media without any initiating intimal tear.
• Although aortography has a sensitivity of 88% and a specificity of 94% in experienced hands, it has largely been replaced by noninvasive diagnostic techniques. It is helpful however, in determining the site of dissection, the relationship of the dissection the major aortic branches, as well as identifying the true and false lumens.
• Additionally, coronary angiography can be preformed at the same time. False negatives occur if the false lumen is already thrombosed, or when there is simultaneous opacification of both lumens.

Advantages of Aortogram

• The advantage of the aortogram in the diagnosis of aortic dissection is that it can delineate the extent of involvement of the aorta and branch vessels and can diagnose aortic insufficiency.

Disadvantages of Aortogram

• The disadvantages of the aortogram are that it is an invasive procedure and it requires the use of iodinated contrast material.