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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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Tags: Vascular Tag this Diagnosis.

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

Blood Test

Finding SensitivitySpecificity Comments, Study
Elevated D-dimer Edit 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

History

Finding SensitivitySpecificity Comments, Study
Chest Pain Edit Sensitivity = 67%

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

Pain radiating to Back Edit Sensitivity = 32%

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

Imaging

Finding SensitivitySpecificity Comments, Study
MRI Edit 98%98%

Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999

Trans-Esophageal Echocardiography Edit 98%95%

Limited for portions of the aortic arch

Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999

Physical Exam

Finding SensitivitySpecificity Comments, Study
Focal Neurological Signs Edit 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

Hypertension
Duplicate Edit
73%55%

history of

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

Hypertension
Duplicate Edit
Sensitivity = 49%

at time of presentation

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

Untagged

Finding SensitivitySpecificity Comments, Study
Chest CT Edit 100%98%

Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999

Diastolic Murmur Edit 28%80%

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

Friction rub, pericardial Edit Sensitivity = 6%

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

Marfan Syndrome Edit Sensitivity = 5%

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

Pain Edit Sensitivity = 90%

Anywhere

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

Pulse Deficit Edit 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

Shock Edit Sensitivity = 19%

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

Tearing Pain Edit 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

Widened mediastinum Edit 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