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Angiography is theoretically the most accurate test, however it's rarely if ever done in practice. You wouldn't often expect to see an 'equivocal' dissection, given both the clinical presentation and the diagnostic accuracy of the tests mentioned hereafter.

Practically, ECHO and CT both have sensitivities approaching 99% - ECHO is preferred as it's cheaper, pretty much as accurate and can be done faster.
 

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Angiography is theoretically the most accurate test, however it's rarely if ever done in practice. You wouldn't often expect to see an 'equivocal' dissection, given both the clinical presentation and the diagnostic accuracy of the tests mentioned hereafter.

Practically, ECHO and CT both have sensitivities approaching 99% - ECHO is preferred as it's cheaper, pretty much as accurate and can be done faster.
P.S. you really don't need to sweat these issues.

If a question comes up on this, it's going to be "X with a hx of Marfan's/ HTN presents with sudden onset tearing chest pain radiating to the back and discrepancy between BP in arms - what's the best next diagnostic step?' in which case you go ECHO. The other question that might come up in this is a case giving you very elevated BP and asking what the best next step is - in which case you go antihypertensives before ECHO.

The questions are a lot more fair and straightforward than you would think.
 
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