Title: Multidetector computed tomography scanning is still the gold standard for diagnosis of acute aortic syndromes
Abstract: We read with great interest the case reported by Lebreton et al. w1x who described a false-positive result of a computed tomography suggesting an intramural aortic hematoma which led to unnecessary surgery.Computed tomography scanning has been used for more than two decades to identify acute aortic diseases.Electrocardiogram (ECG)-gated techniques have made it possible to generate motion-free images of the aortic root and coronary arteries, similar to coronary computed tomography angiography imaging.Reports of newer-generation multidetector helical computed tomography scanners show sensitivities of up to 100% and specificities of 98-99% w2x.Data from the International Registry of Acute Aortic Dissection (IRAD) show that for patients with acute aortic syndromes, computed tomography is the most used diagnostic modality (61% of patients) and transthoracic echocardiography and/or transesophageal echocardiography is used first in 33% of patients w3x.Increased risk for complications or mortality in patients with intramural hematoma involving the ascending aorta when the ascending aortic diameter is )4.8 cm or intramural aortic hematoma thickness is )11 mm has been described w4x.The guidelines of the Brazilian Society of Cardiovascular Surgery for treatment of aortic diseases recommend computed tomography as the first diagnostic method in acute aortic syndromes or, if not available immediately, transesophageal echocardiography as a second option w5x.Although, the impact of one false-positive result could be important in a specific patient, we can rely on computed tomography for the diagnosis of acute aortic syndromes and the treatment should not be postponed once the diagnosis is confirmed.