Outline the advantages and disadvantages of a CT scan, Transoesophageal echocardiography, MRI and an aortogram for the evaluation of suspected aortic dissection.
Answer and interpretation
- 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.
- have to move the patient
- iodinated contrast
- cannot assess for AR, LV function or coronaries
- bedside test
- can detect intimal flap, true and false lumen AR, tamponade
- assess LV function
- no contrast needed
- may need anaesthesia/intubation
- may cause undesirable hypertension
- not widely available
- special expertise required
- High sensitivity and specificity
- MR contrast (Gadolinium) has more favourable safety profile
- can detect AR
- Not readily available
- inconvenient (patient motionless for 30 minutes)
- access and monitoring difficult
- limited applicability (claustrophobia, pacemakers)
- will detect intimal flap, AR
- assess LV, tamponade, blocked coronaries (important for surgery in type A dissection)
- not readily available
- large contrast load
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.