Does This Patient Have an Acute Thoracic Aortic Dissection?

Abstract

The presence of pulse deficits or focal neurological deficits increases the likelihood of an acute thoracic aortic dissection in the appropriate clinical setting. Conversely, a completely normal chest radiograph result or the absence of pain of sudden onset lowers the likelihood. Overall, however, the clinical examination is insufficiently sensitive to rule out aortic dissection given the high morbidity of missed diagnosis.

Early recognition of acute thoracic aortic dissection and aneurysm

“…The present study shows that the sudden onset in nature was more likely associated with TAA/TAD. This is in concordance with previous report by Klompas et al [4]. On the other hand, our finding of association with increasing intensity has not been reported in other studies and may explain the evolving nature of thoracic aortic disease.…”

Preliminary development of a clinical decision rule for acute aortic syndromes

“…Acute onset of pain was noted in 89% of cases (31/35) and an abnormal chest radiograph in 79% (26/33), similar to previous literature [6, 9, 17]. Presence or absence of a blood pressure differential, an established risk factor for AAS [6], was not recorded in the charts of 83% (33/40) of cases and 91.3% (157/172) of controls.…”

Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease

“…One other problem was that a fair number of patients with acute aortic disease did not show typical disease presentation. 5 6 15 16 In our study, atypical chief complaints accounted for 31.3% of cases. Previous studies have reported that timely diagnosis of acute aortic disease was challenging, and the rate of missed diagnoses was reported to be 38.2% for acute aortic dissection 1 4 and 42.0% for ruptured aortic aneurysm.…”