EVALUATION OF PATIENTS WITH SUSPECTED AOR TIC DISSECTION

The clinical picture of aortic disection is dominated by severe pain. In differential diagnosis the far more frequent acute myocardial infar ction should chiefly be considered. Further evaluation is therefore on ly indicated when, in addition to pain, there are no signs of infarcti on in the ECG, additional aortic incompetence, pericardial effusion or history of hypertension. In recent years, in addition to contrast ang iography, three non-invasive methods for this diagnosis have been deve loped: computer tomography, biplane esophageal echocardiography and ma gnetic resonance imaging. The sensitivity, specificity, advantages and disadvantages of these four methods are compared. In the individual c enter, according to the availability and expertise of the investigator s, one method should be used as the first diagnostic tool. Only in a m inority of patients should a second method be necessary until the diag nosis is confirmed or excluded, as is shown in our own series. A limit ation to one, and in difficult situations possibly two, methods is not only important from the economic point of view but also to save time, since in aortic type A dissection surgery should be performed without delay.