Critical Issues in the Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection

In an attempt to identify patients at very low risk for acute nontraumatic thoracic aortic dissection, do not use existing clinical decision rules alone. The decision to pursue further workup for acute nontraumatic aortic dissection should be at the discretion of the treating physician.

In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.

In adult patients with suspected nontraumatic thoracic aortic dissection, emergency physicians may use computed tomography (CT) angiogram to exclude thoracic aortic dissection because it has accuracy similar to that of transesophageal echocardiogram (TEE) and magnetic resonance angiogram (MRA).

In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on an abnormal bedside transthoracic echocardiogram (TTE) result to definitively establish the diagnosis of thoracic aortic dissection.

In adult patients with suspected nontraumatic thoracic aortic dissection, immediate surgical consultation or transfer to a higher level of care should be considered if a transthoracic echocardiogram (TTE) is suggestive of aortic dissection. [Consensus recommendation]

In adult patients with acute nontraumatic thoracic aortic dissection, decrease blood pressure and pulse if elevated. However, there are no specific targets that have demonstrated a reduction in morbidity and mortality.