Six Key Considerations on Aortic Dissection for Radiologists

The untimely passing of Sen. Lindsey Graham from aortic dissection puts a spotlight on one of the most time-sensitive diagnoses in emergency imaging. In an interview with Diagnostic Imaging, cardiologist Alan C. Braverman, MD, FACC, discussed the risk factors and imaging findings that can support earlier detection of aortic dissection.¹ Here are key considerations from the interview.

How Common is Hypertension in Cases of Aortic Dissection?

Dr. Braverman noted that hypertension is the single most common risk factor for aortic dissection.

“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,” said Dr. Braverman, the head of general cardiology with the John T. Milliken Department of Medicine at the Washington University School of Medicine.¹

Are There Other Risk Factors in the Clinical History that May Suggest Possible Aortic Dissection?

Family history of aortic disease and genetic conditions such as Marfan syndrome and Loeys-Dietz syndrome are additional recognized risk factors for aortic dissection, underscoring the value of reviewing patient history for connective tissue disease or a family pattern of aortic events.

Can Chest X-Ray Provide Signs of Aortic Dissection?

While emphasizing that chest X-ray (CXR) doesn’t provide a definitive diagnosis, Dr. Braverman said specific chest X-ray findings may trigger additional 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,” pointed out Dr. Braverman.¹

However, Dr. Braverman cautioned that CXRs do not rule out aortic dissection, noting that at least 20 percent of those with aortic dissection have a normal CXR.¹

Can Point-of-Care Ultrasound Be Helpful in Detection of Aortic Dissection?

Like CXR, POCUS has recognized limitations for aortic dissection, but Dr. Braverman noted that it can serve as a useful screening step to facilitate further workup in the appropriate clinical setting.

What is the Gold Standard for Imaging Detection of Aortic Dissection?

“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," emphasized Dr. Braverman.¹

Can Timely Detection and Treatment Have an Impact for Patients with Aortic Dissection?

Despite high pre-hospital mortality for aortic dissection, Dr. Braverman noted that among patients who survive hospitalization, roughly 90 percent are “alive and well” one year later, a reminder that timely, accurate imaging diagnosis has a direct bearing on long-term survival.¹

Additionally, a 2023 national registry study found that patients discharged after surgical treatment for type A aortic dissection had 96 percent and 91 percent survival rates at one and three years, respectively whereas non-surgical management led to 88 percent and 78 percent survival rates respectively at one and three years.²

The authors of the aforementioned study also noted that survival rates at one and three years for surgical treatment of type B aortic dissection were 89 percent and 83 percent, respectively, and non-surgical management achieved 89 percent and 77 percent survival rates at one and three years.²

Final Notes

Sen. Graham’s recent death, reportedly from aortic dissection due to arteriosclerotic cardiovascular disease, is a current reminder of how quickly this condition can progress and how much diagnostic accuracy matters. For radiologists, recognizing risk factors and pertinent imaging clues remain central to improving outcomes.

References

1. Hall J. Keys to detecting aortic dissection: an interview with Alan Braverman, MD. Available at: https://www.diagnosticimaging.com/view/keys-to-detecting-aortic-dissection-interview-alan-braverman-md . Published September 19, 2025. Accessed July 13, 2026.

2. Pedersen MW, Kragholm K, Oksjoki R, et al. Characteristics and outcomes in patients with acute aortic dissection: a nationwide registry study. Ann Thorac Surg. 2023;116(6):1177-1184.