acute aortic syndrome

Question 1

56 yr F P/W ccp radiate to back , lasted for 3/24 , with good relief with 5 mg of IV morphine , beside aortic dissection , given three more DD under acute aortic syndrome

Answer 1

1- Intramural hematoma
2- penetrating aortic ulcer
3- Traumatic disruption of the aorta

Question 2

List and justify 5 work up investigations that you work up in acute aortic syndrome

Answer 2

1- ECG : look for complications ( coronary artery involvement usually RCA , myocardial ischemia )
look for alternative Dx eg PE
2- CXR : look for abnormal aortic contour , double calcium sign , pleural effusion
3- TTE : look for complications :pericardial tamponade
4- TOE : look for complication ( pericardial effusion) , assess LV
5- CTPA : high sn and sp ( 97% ) both : can identify extent of dissection ( type A or B ) and branch artery involvement