Aortic dissection: a review of the diagnosis and initial management

Aortic dissection is a medical emergency which carries a high mortality, particularly if undiagnosed and untreated. The diagnosis may be overlooked because the 'classical' history, examination and imaging signs are present in only a minority of cases. After reflecting on the underlying pathophysiology, this review examines aspects of the history and examination which should alert Acute Physicians to a possible diagnosis of aortic dissection. The relative benefits of different imaging techniques are summarised, along with the prognosis and treatment for different types of aortic dissection. Finally a case of aortic dissection which went undiagnosed for a month is presented to illustrate some of the key teaching points raised in this article.