title: The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome.
abstract: The term "acute aortic syndrome" (AAS) encompasses several non-traumatic life-threatening pathologies of the thoracic aorta presenting in patients with a similar clinical profile. These include aortic dissection, intramural haematoma and penetrating atherosclerotic ulcers. These different pathological entities can be indistinguishable on clinical grounds alone and may be confused with other causes of chest pain, including myocardial infarction. Multidetector-row CT (MDCT) is the current modality of choice for imaging AAS with a sensitivity and specificity approaching 100%. Early diagnosis and accurate radiological classification is associated with improved clinical outcomes in AAS. We review the characteristic radiological features of the different pathologies that encompass AAS and highlight the vital role of MDCT in determining the management of these life-threatening conditions.
authors.affiliation: Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Abbas
authors.forename: I W
authors.initials: IW
authors.lastname: Brown
authors.forename: C R
authors.initials: CR
authors.lastname: Peebles
authors.forename: S P
authors.initials: SP
authors.lastname: Harden
authors.forename: J S
authors.initials: JS
authors.lastname: Shambrook
mesh_terms: D000784:Aortic Dissection / Q000145:classification / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001014:Aortic Aneurysm / Q000145:classification / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004867:Equipment Design; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D061330:Multidetector Computed Tomography / Q000295:instrumentation; D012680:Sensitivity and Specificity; D013577:Syndrome; D014456:Ulcer / Q000000981:diagnostic imaging
references.citation: Circulation. 2003 Mar 4;107(8):1158-63
references.pmid: 12615795
references.citation: Clin Radiol. 2005 Dec;60(12):1256-67
references.pmid: 16291307
references.citation: Eur Heart J. 2006 Feb;27(4):489-98
references.pmid: 16227309
references.citation: Circulation. 2005 Dec 13;112(24):3802-13
references.pmid: 16344407
references.citation: Prog Cardiovasc Dis. 1998 May-Jun;40(6):563-89
references.pmid: 9647610
references.citation: J Cardiovasc Surg (Torino). 2014 Apr;55(2 Suppl 1):133-44
references.pmid: 24796906
references.citation: Semin Ultrasound CT MR. 2012 Jun;33(3):222-34
references.pmid: 22624967
references.citation: Postgrad Med J. 2012 Nov;88(1045):661-7
references.pmid: 22984184
references.citation: J Vasc Surg. 2014 Feb;59(2):321-6
references.pmid: 24139979
references.citation: Eur Heart J. 2001 Sep;22(18):1642-81
references.pmid: 11511117
references.citation: J Cardiothorac Surg. 2006 Sep 12;1:26
references.pmid: 16968547
references.citation: J Cardiovasc Comput Tomogr. 2013 Jul-Aug;7(4):267-72
references.pmid: 23770125
references.citation: Radiographics. 2005 Oct;25 Suppl 1:S229-44
references.pmid: 16227493
references.citation: Eur Heart J. 2012 Jan;33(1):26-35b
references.pmid: 21810861
references.citation: J Thorac Cardiovasc Surg. 2002 Jun;123(6):1051-9
references.pmid: 12063450
references.citation: Ann Thorac Surg. 2007 Feb;83(2):S835-41; discussion S846-50
references.pmid: 17257937
references.citation: J Endovasc Ther. 2013 Jun;20(3):265-72
references.pmid: 23731294
references.citation: Cardiovasc Intervent Radiol. 2011 Oct;34(5):890-902
references.pmid: 21072634
references.citation: Radiographics. 2009 May-Jun;29(3):791-804
references.pmid: 19448116
references.citation: Circulation. 2010 Apr 6;121(13):e266-369
references.pmid: 20233780
references.citation: Radiol Clin North Am. 2003 Nov;41(6):1153-69
references.pmid: 14661663
references.citation: Eur Heart J. 1995 Jan;16(1):126-8
references.pmid: 7737209
references.citation: J Cardiovasc Surg (Torino). 2012 Feb;53(1 Suppl 1):83-90
references.pmid: 22433727
references.citation: Radiology. 2003 Aug;228(2):430-5
references.pmid: 12819341
references.citation: Radiology. 2014 Jun;271(3):848-55
references.pmid: 24617732
references.citation: Heart. 2001 Apr;85(4):365-8
references.pmid: 11250953
references.citation: Circulation. 2010 Jun 29;121(25):2780-804
references.pmid: 20530003
references.citation: Lancet. 2008 Jul 5;372(9632):55-66
references.pmid: 18603160
references.citation: J Endovasc Ther. 2014 Apr;21(2):324-8
references.pmid: 24754294
references.citation: J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S208-12
references.pmid: 23260434
references.citation: Am J Med. 2002 Oct 15;113(6):468-71
references.pmid: 12427495
references.citation: Circulation. 2003 Aug 5;108(5):628-35
references.pmid: 12900496
references.citation: JAMA. 2000 Feb 16;283(7):897-903
references.pmid: 10685714
references.citation: Radiographics. 2009 Mar-Apr;29(2):537-52
references.pmid: 19325064
references.citation: J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S92-7; discussion S142-S146
references.pmid: 21092805
references.citation: Circulation. 2010 Jul 13;122(2):184-8
references.pmid: 20625143
references.citation: Am Heart J. 1981 Feb;101(2):195-214
references.pmid: 7008565
references.citation: AJR Am J Roentgenol. 2009 Oct;193(4):928-40
references.pmid: 19770313
references.citation: Radiographics. 2000 Mar-Apr;20(2):309-20
references.pmid: 10715333
references.citation: Eur J Radiol. 2013 Dec;82(12):2392-8
references.pmid: 24120225
references.citation: Arch Intern Med. 2000 Oct 23;160(19):2977-82
references.pmid: 11041906
references.citation: N Engl J Med. 1987 Oct 22;317(17):1060-7
references.pmid: 3309654
references.citation: Circulation. 2003 Aug 5;108(5):583-9
references.pmid: 12874185
references.citation: AJR Am J Roentgenol. 2011 Mar;196(3):W260-72
references.pmid: 21343473
references.citation: Insights Imaging. 2012 Dec;3(6):561-71
references.pmid: 23129238
references.citation: Eur J Vasc Endovasc Surg. 2009 Feb;37(2):149-59
references.pmid: 19097813
references.citation: Radiographics. 2003 Oct;23 Spec No:S93-110
references.pmid: 14557505
references.citation: Radiology. 1996 Oct;201(1):37-41
references.pmid: 8816517
references.citation: Radiology. 1997 Apr;203(1):32-6
references.pmid: 9122413
references.citation: Curr Probl Surg. 1992 Dec;29(12):913-1057
references.pmid: 1291195
references.citation: AJR Am J Roentgenol. 2013 Apr;200(4):805-11
references.pmid: 23521452
references.citation: Circulation. 2002 Jul 16;106(3):342-8
references.pmid: 12119251
references.citation: J Thorac Imaging. 2001 Jan;16(1):35-46
references.pmid: 11149691
references.citation: Clin Radiol. 2013 Aug;68(8):753-9
references.pmid: 23541075
references.citation: AJR Am J Roentgenol. 2014 Mar;202(3):656-65
references.pmid: 24555605
references.citation: Ann Thorac Surg. 2014 Jun;97(6):1991-6; discussion 1996-7
references.pmid: 24786861
references.citation: Eur Heart J Cardiovasc Imaging. 2013 Jan;14(1):15-23
references.pmid: 23109648
references.citation: Cardiol Clin. 1999 Nov;17(4):637-57
references.pmid: 10589337
references.citation: JACC Cardiovasc Imaging. 2014 Apr;7(4):406-24
references.pmid: 24742892
references.citation: J Am Coll Cardiol. 2004 Feb 18;43(4):665-9
references.pmid: 14975480
references.citation: AJR Am J Roentgenol. 2003 Aug;181(2):309-16
references.pmid: 12876003
references.citation: Heart. 2004 Apr;90(4):372-4
references.pmid: 15020504
references.citation: Am J Cardiol. 2000 Sep 15;86(6):664-8
references.pmid: 10980220
references.citation: Ann Thorac Surg. 1970 Sep;10(3):237-47
references.pmid: 5458238
references.citation: Radiology. 2011 Mar;258(3):705-13
references.pmid: 21212368
references.citation: Thorac Cardiovasc Surg. 2015 Mar;63(2):97-112
references.pmid: 24752872
references.citation: Mayo Clin Proc. 2004 Oct;79(10):1252-7
references.pmid: 15473405
references.citation: J Vasc Surg. 2012 Jan;55(1):10-5
references.pmid: 22047830
references.citation: Clin Radiol. 2013 Jul;68(7):741-8
references.pmid: 23582433
references.citation: Circulation. 2008 Mar 18;117(11):1460-73
references.pmid: 18347222
references.citation: Circulation. 2009 Sep 15;120(11 Suppl):S292-8
references.pmid: 19752382
references.citation: J Vasc Surg. 2014 Apr;59(4):1134-43
references.pmid: 24661897
references.citation: Radiographics. 1999 Jan-Feb;19(1):45-60; quiz 149-50
references.pmid: 9925391
references.citation: Ann Thorac Surg. 2013 Jul;96(1):39-42
references.pmid: 23684160
references.citation: Radiographics. 2010 Mar;30(2):445-60
references.pmid: 20228328
references.citation: Heart. 2009 Jul;95(14):1130-9
references.pmid: 19131440
references.citation: Ann Thorac Surg. 2008 Mar;85(3):987-92
references.pmid: 18291184
references.citation: J Thorac Cardiovasc Surg. 2004 May;127(5):1393-9; discussion 1399-1401
references.pmid: 15115998
references.citation: Am Surg. 2008 May;74(5):364-80
references.pmid: 18481490
references.citation: Chest. 2002 Jul;122(1):311-28
references.pmid: 12114376
references.citation: Circulation. 2005 Mar 1;111(8):1063-70
references.pmid: 15710757
references.citation: Arch Intern Med. 2006 Jul 10;166(13):1350-6
references.pmid: 16831999
references.citation: N Engl J Med. 1997 Jun 26;336(26):1876-88
references.pmid: 9197217
references.citation: AJR Am J Roentgenol. 2009 Sep;193(3):895-905
references.pmid: 19696307
references.citation: Lancet. 1997 May 17;349(9063):1461-4
references.pmid: 9164331