Which diagnostic test is considered the gold standard for aortic dissection?

The gold standard for diagnosing aortic dissection has traditionally been aortography, also known as invasive angiography. Aortography allows for detailed visualization of the aorta and can accurately identify the presence, location, and extent of the dissection. This imaging technique provides direct images of the aorta's lumen and helps differentiate between true and false lumens.

Although other imaging modalities like computed tomography angiography (CTA) and transesophageal echocardiogram (TEE) are frequently used in practice due to their availability, speed, and non-invasive nature, they are considered secondary in terms of evidence strength when confirming an aortic dissection. Aortography remains the definitive method due to its ability to directly assess the vascular structure and provide critical information needed for management decisions, such as surgical intervention.

While chest X-ray (CXR) can offer initial clues, such as widened mediastinum, it lacks the specificity and sensitivity to confirm a diagnosis of dissection. In summary, aortography is considered the gold standard due to its comprehensive capabilities in diagnosing and delineating the precise nature of aortic dissections.