Aortic Dissection: Sensitivity and Specificity

Introduction: Part of the spectrum of acute aortic syndromes, involving separation of the intima from the media of the aorta. This can progress to rupture as well as causing end-organ ischemia by involving branch arteries.

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The sensitivity and specificity of findings for Aortic Dissection are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Chest CT	100%	98%	Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
MRI	98%	98%	Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
Trans-Esophageal Echocardiography	98%	95%	Limited for portions of the aortic arch Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
Widened mediastinum	90%	90%	on chest x-ray (various measures). For example, left mediastinal width >= 4.95 cm Study: Emerg Radiol. 2012 Aug;19(4):309-15. PMID: 22415593

Specific Findings

Pulse Deficit

34.2%

94%

i.e. differential pulse count in different vessels versus the heart

Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Sensitive Findings

Elevated D-dimer

Sensitivity = 94%

Obviously non-specific, as many other causes of chest pain cause elevated D-dimer (e.g. Pulmonary Embolism).

Study: J Emerg Med. 2008 May;34(4):367-76. PMID: 18207693

Pain

Sensitivity = 90%

Anywhere

Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Diastolic Murmur	28%	80%	Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Hypertension Duplicate	73%	55%	history of Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Chest Pain	Sensitivity = 67%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Hypertension Duplicate	Sensitivity = 49%		at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Tearing Pain	Sensitivity = 39%		The two studies that reported specificity in this article had widely varied sensitivity. This is a pooled sensitivity from several articles. Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Pain radiating to Back	Sensitivity = 32%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Shock	Sensitivity = 19%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Focal Neurological Signs	Sensitivity = 17%		Results too variable to report but PLR 6-33, so good positive predictive value. Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Friction rub, pericardial	Sensitivity = 6%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Marfan Syndrome	Sensitivity = 5%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527