Patients with Acute Thoracic Aortic Dissection: A One-Year Case Series of Patients Presenting to an ED

Thoracic dissection is an often fatal disease. Although physicians must have a high level of suspicion for this disorder, up to 38% of patients with dissection do not have it suspected on evaluation, and up to 28% are found on autopsy not to have been correctly diagnosed. Although rare, thoracic aortic dissection is the most common lethal disease affecting the aorta and more common than abdominal aortic aneurysm (AAA) rupture. Mortality can be as high as 1–2% per hour, making quick and accurate diagnosis important. This is made more complex by the various presentations of thoracic dissection, based on area of dissection, and includes: severe chest pain, back pain, neck and jaw pain, abdominal and back pain, neurologic complications (lightheaded, diaphoresis, nausea/vomiting, stroke, paraplegia), and fever of unknown origin. Patients may have acute aortic regurgitation, pulse differences, abnormal electrocardiograms including heart block or acute myocardial infarction, and tamponade. Hoarseness, hemoptysis, pleural effusions and hematemesis, loss of renal perfusion, and extremity ischemia are also possible.
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research