[Acute aortic syndrome. A thoracic emergency--unfortunately with a large selection of symptoms]

Acute aortic arch syndrome is a medical emergency associated with a high mortality rate. In view of the great variation in symptomatology, this condition can readily be overlooked. A carefully obtained history (pain!), a thorough physical examination (differences in pulse and blood pressure) may be suspicious for acute aortic arch syndrome, which today can be reliably and rapidly diagnosed by noninvasive imaging (CT, TEE). Confirmation of the suspected diagnosis must be followed by further intensive medical surveillance (Stanford B) or, in the event of involvement of the ascending aorta or aortic arch (Stanford A), referral without delay to a cardiosurgical center. Apart from a further shortening of the time lapse between diagnosis establishment and emergency surgery, new therapeutic (e.g. stenting) and surgical procedures may improve the prognosis of the syndrome. Maybe new diagnostic tools (monoclonal antibodies against aortic myosin and radio-immunoscintigraphy) will help to recognize the aortic syndrome more rapidly.