Clinical Features and Differential Diagnosis of Aortic Dissection: Experience With 236 Cases (1980 Through 1990)
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MATERIAL AND METHODS
We reviewed the medical records of 235 patients (158 men and 77 women) who had 236 aortic dissections between January 1980 and December 1990. Aortic dissection was confirmed by surgical intervention in 162 patients, autopsy examination only in 27, or computed tomography, transthoracic echocardiography, transesophageal echocardiography, magnetic resonance imaging, or angiography (or some combination of these studies) without surgical confirmation in 47. In one patient with type III aortic
Classification of Patients.
The sex and age distributions and the duration of dissection in our group of patients are summarized in Table 1. Men were affected more commonly than women by a ratio of approximately 2:1 for all types of aortic dissection. The peak incidence was in the sixth and seventh decades of life, but the mean age of patients with type I dissection was approximately 6 years less than that of patients with type II or type III aortic dissection.
The aortic dissection was acute in 158 patients (67%) and
DISCUSSION
The incidence of acute aortic dissection, the most common fatal condition that involves the aorta, may be increasing in the industrialized world.10 If this condition is unrecognized and untreated, the related mortality is high during the first 48 hours.1, 2, 3, 4, 5 Despite major advances in medical and surgical therapy and in rapid and accurate noninvasive diagnostic techniques, a high index of clinical suspicion by the attending physician that leads to early definitive diagnosis is
CONCLUSION
Because of the diverse manifestations of acute aortic dissection and the fatal outcome if it is untreated, the attending physician must have a high index of clinical suspicion for this condition. In a patient, particularly one who has hypertension, with a catastrophic illness, an aortic murmur, and unexplained physical findings of vascular origin, aortic dissection should always be included in the differential diagnosis, and an effective screening test should promptly be performed. As was
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