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Potentially life-threatening emergency
Aortic dissection
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Aortic dissection

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Contributors: Corey J. Wasilnak MD, Benjamin L. Mazer MD, MBA, Ryan Hoefen MD, PhD, Bruce Lo MD
Other Resources UpToDate PubMed

Alerts and Notices

Synopsis

Aortic dissection : Abdominal pain, Chest pain
Emergent Care / Stabilization:
If suspicion is high, based on history of present illness (HPI), examination, and/or patient history:
  • Assess vital signs.
  • Establish reliable intravenous (IV) access.
  • Blood pressure and heart rate control.
  • Analgesia.
  • CT angiogram of chest / abdomen / pelvis.
  • Expedited consultation with vascular specialist.
Diagnosis Overview:
Aortic dissection is an intramural tear of the aorta. Aortic dissection is a life-threatening emergency. Tears often occur in the intimal layer of the aorta, with blood collecting in the medial layer. Back pain is the common presenting symptom, but it may also present with chest pain, dyspnea, or a new neurologic deficit. Syncope and hypotension occur less frequently. Aortic dissections most often occur in older men.

Aortic dissection can arise from several etiologies:
  • Blunt trauma to chest / abdomen
  • Chronic hypertension or hypertensive emergency
  • Aortic atherosclerosis
  • Sympathomimetic abuse / intoxication (eg, cocaine)
  • Connective tissue disease (eg, Marfan syndrome)
  • Acute increase in intrathoracic / intraabdominal pressure (eg, weight lifting, labor)
  • Recent aortic instrumentation / procedure
  • Aortic aneurysm dissection (less common)
The Stanford classification system is commonly used to differentiate types of aortic dissection based on anatomical location:
  • Type A – dissection involving ascending aorta
  • Type B – dissection that does not involve ascending aorta (ie, aortic arch and descending aorta)
The DeBakey classification (less commonly used):
  • DeBakey I – ascending and descending
  • DeBakey II – ascending only
  • DeBakey III – descending only
Beta blockers are the primary medical treatment. Surgical intervention is indicated for many types of aortic dissection. Even with appropriate treatment, mortality from aortic dissection is relatively high.

Related topic: cystic medial necrosis

Codes

ICD10CM:
I71.00 – Dissection of unspecified site of aorta

SNOMEDCT:
308546005 – Dissection of aorta

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:08/16/2022
Last Updated:11/29/2022
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Potentially life-threatening emergency
Aortic dissection
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A medical illustration showing key findings of Aortic dissection : Abdominal pain, Chest pain
Imaging Studies image of Aortic dissection - imageId=8357567. Click to open in gallery. caption: '<span>Axial image from CT scan of the chest demonstrating dissection of the thoracic aorta. This is a type A dissection involving the ascending and descending thoracic aorta.</span>'
Axial image from CT scan of the chest demonstrating dissection of the thoracic aorta. This is a type A dissection involving the ascending and descending thoracic aorta.

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