THORACIC AORTIC DISSECTION OR ANEURYSM - CLINICAL PRESENTATION, DIAGNOSTIC-IMAGING AND INITIAL MANAGEMENT IN A TERTIARY REFERRAL CENTER

Spontaneous thoracic aortic dissection carries a high mortality despit e progress in diagnosis and treatment. Early and accurate diagnosis is paramount and dependent on clinical and diagnostic imaging skills. A retrospective review of 55 consecutive patients referred with suspecte d thoracic aortic dissection to a medical cardiology department was pe rformed. Clinical follow up was complete to November 1995. Median age was 68 years (range 30-93), with 37 males, 18 females. Presenting comp laints included interscapular chest pain in 23 (42 per cent), neurolog ical deficit in 2 (4 per cent), and limb ischaemia in 8 (15 per cent). On examination 34 (62 per cent) patients had hypertension, 5 (9 per c ent) a pulse deficit and 10 (18 per cent) aortic incompetence. Electro cardiography confirmed myocardial infarction in 1. Chest X-ray showed a widened mediastinum in 37 (67 per cent) patients, Dissection was con firmed in 35 (64 per cent) patients (13-DeBakey Type I, 6-Type II, 14- Type III); 10 had nondissecting aneurysm. Contrast aortography was equ ally sensitive (84 per cent) and more specific (100 per cent vs 80 per cent) than computed tomography for detection of dissection. Surgical repair was performed on 24 patients with concomitant coronary artery b ypass grafting in 6. At follow up 33 patients were alive. Clinical dia gnosis of thoracic aortic dissection or aneurysm may be difficult. Fre quently more than one imaging modality may be required in order to pro vide all of the necessary information for optimal patient management.