60
Treatment
Table 24. Aortic Dissection Detection Risk Score (ADD-RS)
Items
High-Risk Conditions
High-Risk Pain
Features
High-Risk Examination
Features
• Marfan syndrome or other
connective tissue disease
• Family history of aortic
disease
• Known aortic valve disease
• Recent aortic manipulation
• Known thoracic aortic
aneurysm
Chest, back, or
abdominal pain
described as:
• Abrupt onset
• Severe in intensity
• Ripping or tearing
in quality
• Pulse deficit or systolic
blood pressure differential
• Focal neurologic deficit
(with pain)
• Murmur of aortic
regurgitation (new, with
pain)
• Hypotension or shock state
For each risk category, 1 point is assigned if ≥1 risk factors are present. Consequently, the total
ADD-RS will range from 0 to 3. An ADD-RS of 0 points is low risk; 1 point is moderate risk;
and 2 to 3 points is high risk.
Adapted with permission from Hiratzka, et al. Circulation. 2010;121:e266-e369. Copyright
2010, American Heart Association, Inc., and American College of Cardiolog y Foundation.
7.2. AAS: Diagnostic Evaluation (Imaging, Laboratory Testing)
COR LOE
Recommendations
1 C-LD 1. In patients with a suspected AAS, CT is recommended for
initial diagnostic imaging, given its wide availability, accuracy,
and speed, as well as the extent of anatomic detail it provides.
2a C-LD 2. In patients with a suspected AAS, TEE and MRI are
reasonable alternatives for initial diagnostic imaging.
Table 23. Plain Chest X-Ray Findings Suggestive of Aortic
Dissection
Signs of Aortic Dissection on Chest X-Ray
Mediastinal widening
Disruption of the normally distinct contour of the aortic knob
Calcium sign, which appears as a separation of the intimal calcification from the aortic
wall of >5 mm
Double density appearance within the aorta
Tracheal deviation to the right
Deviation of the nasogastric tube to the right
Used with permission from Strayer, et al. Curr Cardiol Rev. 2012;8:152-157.
