A score 1 should be awarded for each of the 3 categories that contain at least one of the listed features
Marfan syndrome
Connective tissue disease
Family history of<unk>  disease
Recent<unk>  manipulation
Known<unk><unk>  aneurysm
Chest, back, or abdominal pain described as:
Abrupt in onset/severe in intensity
AND
Ripping/tearing/sharp or stabbing quality
Evidence of perfusion deficit
Pulse deficit
Systolic BP differential
Focal neurological deficit (in conjunction with pain)
Murmur of<unk>  insufficiency (new or not known to be old and in conjunction with pain)
Hypotension of shock state
Pulse deficit
Systolic BP differential
Focal neurological deficit (in conjunction with pain)
CXR
Abnormal in 90% (3.4x)
Mediastinal widening (seen in 56-63%)
Left sided pleural effusion (seen in 19%)
Widening of<unk>  contour (seen in 48%), displaced calcification (6mm), Calcium sign (look for white line of calcium within<unk>  knob and measure to outer edge of the<unk>  knob - distance greater than 0.5 cm is positive and > 1 cm is highly suspicious for dissection),<unk>  kinking, double density sign
Abnormal in 90% (3.4x)
Mediastinal widening (seen in 56-63%)
Left sided pleural effusion (seen in 19%)
Widening of<unk>  contour (seen in 48%), displaced calcification (6mm), Calcium sign (look for white line of calcium within<unk>  knob and measure to outer edge of the<unk>  knob - distance greater than 0.5 cm is positive and > 1 cm is highly suspicious for dissection),<unk>  kinking, double density sign
D-dimer for ADD-RS ≤ 1 (low or intermediate risk)
CT aortogram chest
Study of choice
Similar sensitivity/specificity to TEE and MRA
Study of choice
Similar sensitivity/specificity to TEE and MRA
ECG
LVH on admission ECG (3.2x)
Ischemia (esp inferior) - 15%
Nonspec ST-T changes - 40%
Bedside US
Can help in ruling in patients when AOFT is >4cm
Rule out pericardial effusion and tamponade, especially in hypotension, syncope, dyspnea
TEE has a sensitivity of 98% and 95% specific
LVH on admission ECG (3.2x)
Ischemia (esp inferior) - 15%
Nonspec ST-T changes - 40%
Can help in ruling in patients when AOFT is >4cm
Rule out pericardial effusion and tamponade, especially in hypotension, syncope, dyspnea
TEE has a sensitivity of 98% and 95% specific
Type A
Involves any portion of ascending aorta
Type B
Isolated to descending aorta
Involves any portion of ascending aorta
Isolated to descending aorta
Nontraumatic thoracic aortic dissection
Acute coronary syndromes 
Coronary artery dissection
STEMI
Left ventricular aneurysm
Non-STEMI
Left ventricular pseudoaneurysm
Unstable angina