The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines

Abstract

Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.

Plasma Lipidomics Identifies Unique Lipid Signatures and Potential Biomarkers for Patients With Aortic Dissection

“…Owing to the diagnostic challenges, such as rapidly propagating pathology, non-specific signs, analogy with other acute conditions, non-discrete symptomatology, and lack of management infrastructure, untimely diagnosis and/or misdiagnosis of AD remain common, which could markedly deteriorate patient outcomes (10). Currently, only D-dimer was used as the clinically relevant biomarker in the condition of suspected AD, with a specificity of 47% and a sensitivity of 97% (11).…”

The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis

“…D-dimer levels in patients with AAD are significantly higher than in other diseases in which chest pain is a prominent symptom (such as acute coronary syndrome), except acute pulmonary embolism [ 44 , 45 ]. However, there are no accepted cut-off values to distinguish AAD from acute coronary syndrome in current studies [ 45 , 46 ]. The similarity of AAD to acute coronary syndrome is a particular problem.…”

“…The similarity of AAD to acute coronary syndrome is a particular problem. Despite improvements in diagnostic measures, including imaging and biomarkers, misdiagnosis of AAD remains common [ 46 ]. It remains a critical topic to explore more appropriate biomarkers for the early diagnosis of AAD in current research.…”

Exaggerated Autophagy in Stanford Type A Aortic Dissection: A Transcriptome Pilot Analysis of Human Ascending Aortic Tissues

“…Hence, our knowledge of aortic dissection is limited to clinical manifestations, radiography and histopathology [ 12 , 23 ]. The diagnosis and treatment strategies based on these aspects are unsatisfactory, and the rates of misdiagnosis and mortality remain high [ 24 ]. Therefore, molecular pathological studies on aortic dissection are necessary.…”