Keys to Detecting Aortic Dissection: An Interview with Alan Braverman, MD

It has been estimated that up to 50 percent of those who have acute dissection in the ascending aorta may die before they get to the hospital. However, for those who survive hospitalization for acute aortic dissection, Alan Braverman, M.D., noted that 90 percent are “alive and well” one year later.

In a recent interview with Diagnostic Imaging, Dr. Braverman emphasized that the knowledge of common risk factors in concert with imaging findings may facilitate earlier diagnosis of aortic dissection.

In addition to a family history of aortic diseases and genetic conditions, such as Marfan syndrome and Loeys-Dietz syndrome, hypertension is another common risk factor for the development of aortic dissection, according to Dr. Braverman, the head of general cardiology with the John T. Milliken Department of Medicine at the University of Washington School of Medicine.

“About 75 percent of people with an aortic dissection have underlying hypertension and, importantly, they don't have to have severe, uncontrolled hypertension. Just the presence of hypertension, even when controlled, can be a risk factor because it can affect the architecture of the aorta,” pointed out Dr. Braverman.

While noting the limitations of point-of-care ultrasound (POCUS) and chest X-ray, Dr. Braverman said they can serve as useful screening tools for triggering subsequent imaging.

“Sometimes the shadow of the aorta in the mediastinum around the heart will be enlarged because the aorta has stretched because of the dissection, or there'll be other evidence on a chest X-ray that heighten your suspicion,” noted Dr. Braverman.

However, Dr. Braverman said computed tomography (CT) provides a highly sensitive gold standard.

“A contrast CT scan, especially when it's gated so it doesn't have a lot of motion artifacts, has at least 95 to 98 percent ability to detect an aortic dissection, so that is the most commonly performed test,” added Dr. Braverman.

(Editor’s note: For related content, see “Pertinent Insights into the Imaging of Patients with Marfan Syndrome,” “Image IQ Quiz: Middle-Aged Female with Chest Pain, Back Pain and Shortness of Breath” and “AI-Powered Algorithm May Enhance CT Assessment of Aortic Dissection.”)

For more insights from Dr. Braverman, watch the video below.