A life-threatening tear in the inner layer (intima) of the aorta. Causes and risk factors: hypertension, Marfan syndrome, trauma.

Clinical presentation

• Severe tearing or ripping chest pain, fainting, sweating, vomiting, pulse deficits or different BP between the arms.

Classification

• Stanford type A: involves the ascending aorta (may extend to the arch or descending aorta) – urgent surgery.

• Stanford type B: descending aorta only – may be managed medically unless complications arise.

Investigations

• Chest X-ray: abnormal aortic contour, double aortic knuckle.

• CT aortogram: key test for diagnosis and assessment.

Management

• Consult a specialist and refer to a high-level specialised hospital.