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Aortic Dissection

An aortic dissection, although uncommon, begins with a tear in the inner layer of the aortic wall of the thoracic aorta. The aortic wall is made up of three layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency.

 

Illustration of aortic dissection
Click Image to Enlarge

 

What causes aortic dissection?

The cause of aortic dissection is still under investigation. However, there are several risk factors associated with aortic dissection, such as:

  • hypertension (high blood pressure)

  • connective tissue disorders, such as Marfan's disease, Ehlers-Danlos syndrome, and Turner's syndrome

  • cystic medial disease (a degenerative disease of the aortic wall)

  • aortitis (inflammation of the aorta)

  • atherosclerosis

  • existing thoracic aneurysm

  • bicuspid aortic valve - presence of only two cusps, or leaflets, in the aortic valve, rather than the normal three cusps

  • trauma

  • coarctation of the aorta (narrowing of the aorta)

  • hypervolemia (excess fluid or volume in the circulation)

  • polycystic kidney disease (a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys)

What are the symptoms of aortic dissection?

The most commonly reported symptom of an acute aortic dissection is severe, constant chest and/or upper back pain, sometimes described as "ripping" or "tearing." The pain may be "migratory," moving from one place to another, according to the direction and extent of the dissection.

How is aortic dissection diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following:

  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • transesophageal echocardiogram (TEE)- a diagnostic procedure that uses echocardiography to assess the heart's function and structures. A transesophageal echocardiogram is performed by inserting a probe with a transducer down the esophagus. By inserting the transducer in the esophagus, TEE provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue.

The physician will determine the most appropriate examination. When a diagnosis of aortic dissection is confirmed, immediate intervention, such as surgery, is usually performed.

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