title: Chest radiography for the diagnosis of acute aortic syndrome.
abstract: OBJECTIVE
  We sought to assess the diagnostic accuracy of routine chest radiography for the acute aortic syndrome (dissection, intramural hematoma, penetrating ulcer, or nondissecting aneurysm).
  
  
  METHODS
  During a 6-year period, 216 patients (143 men, 73 women; mean [+/- SD] age, 58 +/- 17 years) underwent chest radiography for suspected acute aortic syndrome. Chest films were re-evaluated blindly for aortic disease, based on an overall impression using standard criteria such as widening of the aortic contour and mediastinal shadow. Findings were matched to tomographic images, anatomical inspection, or both, as the criterion standard; aortic disease was confirmed in 109 (50%) of the patients.
  
  
  RESULTS
  Chest radiography had a sensitivity of 64% (70/109) and a specificity of 86% (92/107) for aortic disease. Sensitivity was 67% (38/57) for overt aortic dissection, 61% (22/36) for nondissecting aneurysm, and 63% (10/16) for intramural hemorrhage or penetrating ulcer. However, sensitivity was lower for pathology confined to the proximal aorta (47% [21/45]) than for disease involving distal aortic segments (77% [49/64]). A receiver operating characteristic curve analysis of aortic diameters failed to identify a threshold for the diagnosis of aortic disease.
  
  
  CONCLUSIONS
  Chest radiography is of limited value for diagnosing the acute aortic syndrome, particularly for conditions confined to the ascending aorta. Since a definitive diagnosis is required in any patient with clinically suspected acute aortic syndrome, routine chest radiography should be replaced by tomographic aortic imaging.
authors.affiliation: Department of Internal Medicine, University Hospital Eppendorf, Hamburg, Germany. kodolitsch@uke.uni-hamburg.de
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Christoph
authors.initials: C
authors.lastname: Dieckmann
authors.forename: Ann G
authors.initials: AG
authors.lastname: Schwartz
authors.forename: Thomas
authors.initials: T
authors.lastname: Hofmann
authors.forename: Caspar
authors.initials: C
authors.lastname: Brekenfeld
authors.forename: Volkmar
authors.initials: V
authors.lastname: Nicolas
authors.forename: Jürgen
authors.initials: J
authors.lastname: Berger
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011859:Radiography; D012680:Sensitivity and Specificity