The hemoglobin may be normal in the presence of acute bleeding. While a cardiac work-up should be pursued, infarction can occur as a result of the dissection and therefore elevation of cardiac enzymes does not rule out the diagnosis. EKG may show LVH as evidence of long-standing hypertension. Additionally, if surgical management is deemed appropriate, the surgeon will want to know as much about the anatomy of the dissection before proceeding to repair. However, as with all MRI studies the patient must be stable and limits the patient with respect to any indwelling or external metallic devices the patient may require.
TEE allows bedside evaluation and is quick to perform.
However, TEE may not be readily available in many practice settings. However, CT lacks the ability to detect aortic regurgitation or define peripheral branch involvement. Like CT there is the risk of IV contrast administration. Likewise, if the false lumen has thrombosed, contrast will not opacify the false lumen. The intimal flap may not be visible if it is located tangential to the x-ray beam.