[Acute aortic syndrome: which type of imaging to use?]

Acute aortic syndrome is an emergency that requires prompt diagnosis and treatment because of its high morbidity and mortality rates. The chosen imaging modality should allow to diagnose or eliminate the presence of an acute aortic syndrome but also identify signs of severity of the aortic disease. Computed tomography, transesophageal echocardiography and MRI have high sensitivity and specificity values and roughly equivalent for the diagnosis of acute aortic syndromes. Computed tomography has the advantage of identifying involvement of aortic collaterals including visceral branches of the abdominal aorta. In clinical practice, Computed tomography is the diagnostic modality the most often performed, followed by trans esophageal echocardiography. If a high clinical suspicion exists for acute aortic syndrome but initial aortic imaging is negative, a second imaging study should be obtained without delay.