Imaging establishes aortic dissection and may demonstrate associated aortic, pleural or cardiac findings.
Preferred imaging and chest X-ray
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CT or MR angiography are the investigations of choice; both are highly sensitive and specific.
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A chest X-ray should be performed. Characteristic findings are broadening of the upper mediastinum and distortion of the aortic knuckle, but these are absent in 10% of cases.
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A left-sided pleural effusion is common.
Electrocardiography and echocardiography
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The electrocardiogram may show left ventricular hypertrophy in patients with hypertension or, rarely, changes of acute myocardial infarction, usually inferior.
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Doppler echocardiography may demonstrate aortic regurgitation, a dilated aortic root and occasionally the dissection flap.
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TOE is particularly helpful because transthoracic echocardiography provides images of only the first 3–4 cm of the ascending aorta.