 Welcome back to emergency medicine video on aortic dissection. In this segment, we'll discuss diagnosis and treatment. If you haven't done so already, please refer to part 1 when we discuss the presentation. The diagnosis of aortic dissection lies in diagnostic imaging. It consists of chest x-ray, ultrasound, and CT scans. In an aortic dissection, a false lumen is created. As that expands, the mediastinum will look wider on the chest x-ray. On this chest x-ray, you can see that the mediastinum is wider. In an aortic dissection, the normal contour of the aorta is also being distorted. On a chest x-ray, it will look like this. You can see the irregular aortic contour. There's also a widened mediastinum as well. In some patients, they'll have a unilateral pleural fusion. Remember how we said that aortic dissection is sometimes very tricky to diagnose? Not only do they not always have typical symptoms, 12% of patients with aortic dissection have a completely normal chest x-ray. Therefore, a high-risk patient is not going to be ruled out by a normal chest x-ray. How about ultrasound? Both a bedside trans thoracic ultrasound and a trans esophageal ultrasound can be used. Ultrasound can detect pericardial fusion in cardiac tamponade. Transesophageal ultrasound is more sensitive in picking up the dissection flap between the true and the false lumen. However, transesophageal ultrasound can only be done in patients who are intubated. CT angiography has high sensitivity and specificity for picking up aortic dissection. It can easily tell us the extent of the dissection and what other branches are involved. It will also demonstrate pericardial effusion. The downside, of course, is for every CT scan, the patient needs to be stable. It requires IV contrast and radiation is involved. Once we diagnose an aortic dissection, what should be the treatment? The treatment is based on the type of the dissection. There are different classification, but we will use this one for our discussion. It is based on whether the ascending aorta is involved. If it is, it is a type A dissection. And it's not type B. Type A dissection is the more worrisome kind, since it can easily go into the pericardium and into the coronary arteries. The treatment is surgical. Type B dissection is treated usually just with medications alone. The medication aims to decrease blood pressure. It usually consists of IV bail blockers. Sometimes the surgeons are involved, depending on the institution. In some, I re-discuss the diagnostic modalities for aortic dissection and its treatment. Remember, aortic dissection is a bad disease. It has high mortality, and patients often have atypical symptoms, making it easy to miss the diagnosis. We hope you find that useful. Thank you for watching.