if you don't see a dissection flap, look hard for intramural haematoma or penetrating ulcer
trauma
diaphragm rupture (usually on the left) is easily missed, look carefully on coronal and sagittal images
blunt aortic injury
arterial phase CT chest
minimal aortic injury
<10mm intimal flap
conservative Rx with BP control and monitor for evolution
severe aortic injury
all other injuries
BP control, Rx other life threatening injuries first then repair
endovascular repair if aorta < 15mm and tear of the mid arch as less mortality and morbidity compared with open repair, but need to sacrifice left brachiocephalic artery so ensure adequate collaterals