CICM SAQ 2010.2 Q13

CT

Advantages:

• easy availability on an emergency basis
• high sensitivity and specificity
• can pick up complications involving the branches ( e.g. ischaemic gut) and
• extent of dissection into abdominal aorta
• easier to monitor the patient than MRI
• detects pericardial effusion.

Disadvantages:

• have to move the patient
• iodinated contrast
• cannot assess for AR, LV function or coronaries

TOE

Advantages:

• bedside test
• can detect intimal flap, true and false lumen AR, tamponade
• assess LV function
• no contrast needed

Disadvantages:

• semi-invasive
• may need anaesthesia/intubation
• may cause undesirable hypertension
• not widely available
• special expertise required

MRI

Advantages:

• High sensitivity and specificity
• MR contrast (Gadolinium) has more favourable safety profile
• can detect AR

Disadvantages:

• Not readily available
• inconvenient (patient motionless for 30 minutes)
• access and monitoring difficult
• limited applicability (claustrophobia, pacemakers)

Aortography

Advantages:

• will detect intimal flap, AR
• assess LV, tamponade, blocked coronaries (important for surgery in type A dissection)

Disadvantages:

• not readily available
• invasive
• large contrast load