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[Clinical assessment of the patient with suspected dissecting aneurysm].

The clinical picture of aortic dissection is dominated by severe pain. In differential diagnosis the far more frequent acute myocardial infarction should chiefly be considered. Further evaluation is therefore only indicated when, in addition to pain, there are no signs of infarction in the ECG, additional aortic incompetence, pericardial effusion or history of hypertension. In recent years, in addition to contrast angiography, three non-invasive methods for this diagnosis have been developed: computer tomography, biplane esophageal echocardiography and magnetic resonance imaging. The sensitivity, specificity, advantages and disadvantages of these four methods are compared. In the individual center, according to the availability and expertise of the investigators, one method should be used as the first diagnostic tool. Only in a minority of patients should a second method be necessary until the diagnosis is confirmed or excluded, as is shown in our own series. A limitation to one, and in difficult situations possibly two, methods is not only important from the economic point of view but also to save time, since in aortic type A dissection surgery should be performed without delay.