The patient should be emergently evaluated for aortic dissection using chest CT with IV contrast. Other diagnostic options include bedside transesophageal echocardiogram, magnetic resonance imaging of the chest, and, in rare circumstances, contrast aortography.4 The decision of which modality to use depends on how stable the patient is, experience of the physician, and availability of the modality in the institution. A transthoracic echocardiogram will not likely provide complete visualization of the aorta to aid in diagnosis. Cardiac biomarkers, fasting lipid profile, and coronary angiogram are helpful but not necessary, especially if they delay timely treatment.4
- Immediate chest CT with IV contrast.
4. Chen K, Varon J, Wenker OC, et al. Acute thoracic aortic dissection: the basics. J Emerg Med 1997;15:859–67.
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