Aortic dissection. Its diagnostic criteria and its diagnostic procedures

The seriousness of aortic dissection has long been recognized. It cannot be over emphasized how important it is to determine whether or not the ascending aorta is involved in the dissection. According to the Stanford classification, dissections were divided into 2 types; type A is a dissection involving the ascending aorta and type B is a dissection limited to the aorta beyond the left subclavian artery. In addition to this, we have proposed that two distinctly different types exist, namely the open-communicated type (O type) which demonstrates communication between the true lumen and the false lumen, and the thrombosed type (or closing type; T type) which, in the acute phase shows no opacification of the false lumen in medical imagings such as CT scan and digital subtraction angiography. In this report, we have analyzed the diagnostic procedures of aortic dissections in their acute phase of patients at our institute. Correct diagnoses of T type dissections were made in 83% of cases and for O type dissections in 48% of cases using CT scans including plain and contrast enhanced CT. Initial suspected diagnoses of O type dissections were made after plain chest X-rays and trans-thoracic echocardiography. These diagnoses were later confirmed through angiography, transesophageal echocardiography and CT scans (including electron-beam CT). On the other hand, in T type patients, precise diagnoses were mainly made using CT scans. In comparison to the other procedures, CT scans proved to be the most efficient and more convenient in the diagnosis of dissection. (author)