Clinical Suspicion of AAD

What would you do if the scan was normal but the clinical suspicion was high?

None of the individual imaging modalities for AAD is perfect. One study created a decision model to determine the 30 day survival of patients who did, and did not, have a second test performed (not including TTE) when the clinical probability of acute dissection was high (>15%).

This review concluded that the 30 day survival of patients with a high probability of dissection was significantly improved when a second test was performed after the first test was negative [2].

Learning bite

It is imperative that if there is a strong clinical suspicion of aortic dissection and the result of the first modality of imaging is normal, a second test should be performed.