Aortic Dissection

 

Aortic dissection is a life-threatening condition where there is a tear in the inner layer of the aorta, leading blood to flow between the layers of the aortic wall, creating a false lumen.

Key Clinical Features

i. Hypertension: A common risk factor for aortic dissection, often present in patients experiencing this condition.
ii. Severe Chest Pain Radiating to the Back: Typically described as a “tearing” or “ripping” pain. The pain may move down the back as the dissection progresses.
iii. Blood Pressure Difference: A significant difference in blood pressure between the right and left arms is a hallmark feature, indicating compromised blood flow due to the dissection.

Risk Factors

i. Genetic Disorders:
ii. Marfan’s Syndrome: A connective tissue disorder that weakens the aortic wall, increasing the risk of dissection.
iii. Ehlers-Danlos Syndrome: Another connective tissue disorder that predisposes patients to aortic dissection due to weakened vascular structures.

Investigations

Chest X-ray
A chest X-ray may reveal a widened mediastinum, which is a classic but non-specific sign of aortic dissection.

Definitive Imaging Studies

i. CT Angiography: The investigation of choice for diagnosing aortic dissection in stable patients, providing detailed images of the aorta and the extent of the dissection.
ii. Transoesophageal Echocardiography (TEE): Preferred for unstable patients and can be performed in the operating room. It provides real-time imaging of the aorta and is valuable when rapid decision-making is needed.