The diagnostic value of imaging techniques for aortic dissection

Advances in ultrasound technology continue to enhance its diagnostic applications in daily medical practice. Bedside echocardiographic examination has become useful to properly trained cardiologists, anesthesiologists, intensivists, surgeons, and emergency room physicians. Cardiac ultrasound can permit rapid, accurate, and noninvasive diagnosis of a broad range of acute cardiovascular pathologies. Although transesophageal echocardiography was once the principal diagnostic approach using ultrasound to evaluate intensive care unit patients, advances in ultrasound imaging, including harmonic imaging, digital acquisition, and contrast for endocardial enhancement, has improved the diagnostic yield of transthoracic echocardiography. Ultrasound devices continue to become more portable, and hand-carried devices are now readily available for bedside applications. This article discusses the application of bedside echocardiography in the intensive care unit. The emphasis is on echocardiography and cardiovascular diagnostics, specifically on goal-directed bedside cardiac ultrasonography.

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“…4). A negative TEE for the diagnosis of aortic dissection, even in a high-risk population, has high negative predictive value (114).…”

Section: Assessment Of the Aortamentioning

confidence: 99%

Bedside echocardiography in the assessment of the critically ill

Beaulieu

2007

Critical Care Medicine

215

111

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“…A previous study has shown that in patients with a high likelihood of dissection all diagnostic modalities had a positive predictive value of over 85%. In patients with a low pre-test likelihood of acute dissection, MRI had a positive predictive value of 100%, whereas CT, TEE and angiography were approximately 50% [19]. Newer data from the IRAD shows an overall sensitivity of 87% for angiography, 88% for TEE, 93% for CT and 100% for MRI.…”

Section: Discussionmentioning

confidence: 99%

Imaging of the aorta

Pemberton

Sahn

2004

International Journal of Cardiology

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“…An analysis by Barbant and colleagues also discusses the importance of pretest probability and the application of Bayes' theorem. 31 These authors reported that when the prevalence of disease was varied from intermediate (10%) to high (50%), the negative predictive value of CT decreased from 98% to 85%, reflecting the need for a second diagnostic test in high-risk populations. 31 In our very high-risk patient, 3 imaging modalities were needed to convincingly diagnose aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

The utility of multiple imaging modalities to diagnose acute aortic dissection

Hurley

Ducharme

2008

CJEM

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A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients. RÉSUMÉUn jeune homme de 21 ans atteint du syndrome de Marfan avec présence connue d'un anévrisme de la racine aortique s'est présenté à l'urgence avec des symptômes évoquant une dissection aiguë de l'aorte. Le patient était stable sur le plan hémodynamique et les pressions artérielles bilatérales des membres supérieurs étaient similaires. Les résultats de la radiographie pulmonaire réalisée sur un appareil portatif n'indiquaient pas d'élargissement du médiastin. Ni la tomodensitométrie avec agent de contraste ni l'angiographie rétrograde de l'aorte n'ont permis de déceler la dissection. Une échocardiographie transoesophagienne subséquente a montré qu'il s'agissait d'une dissection de type A selon la classification de Stanford. Ce cas met en évidence l'utilité d'avoir recours à de multiples techniques d'imagerie médicale pour établir un diagnostic de dissection aortique chez les patients à haut risque.

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The diagnostic value of imaging techniques for aortic dissection

Cited by 37 publications

References 5 publications

Bedside echocardiography in the assessment of the critically ill

Bedside echocardiography in the assessment of the critically ill

Imaging of the aorta

The utility of multiple imaging modalities to diagnose acute aortic dissection

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