CT scanning

Dynamic contrast-enhanced CT scanning is the preferred first investigation in most community hospitals. Diagnosis is much enhanced when spiral CT is available.

The sensitivity ranges between 83 and 100 per cent and the specificity between 90 and 100 per cent for identification of dissection ( Cig.airo┬ž.eLa.l 1.9.93). CT is useful for demonstrating the extent of dissection and the presence of hemopericardium, but can be prone to artefacts. It may be difficult to demonstrate the intimal flap or tear, limiting its value in planning surgery. In 70 per cent of cases it is possible to demonstrate contrast filling both true and false lumens separated by an intimal flap (Fig. .2). Other features suggesting dissection include differing opacification of the true and false lumens, compression of the true lumen by thrombosis in the false lumen, inward displacement of intimal calcification, and irregularity of the contrast-enhanced lumen. Blood may be seen in the aortic wall, peri-aortic tissues, or pericardium as high-attenuation material on unenhanced scans, but these features may also be seen in aortic rupture. If there is strong clinical suspicion despite a negative CT scan, further investigation such as aortography is required.

Fig. 2 Axial enhanced CT image in the same subject as Fig 1, demonstrating the true and false lumens separated by the intimal tear.

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