Acute aortic dissection with tear in ascending aorta not diagnosed until necropsy or operation (for another condition) and comparison to similar cases receiving proper operative therapy.
Acute aortic dissection (AD) with a tear in ascending aorta (AA) is recognized to masquerade occasionally as another condition, and therefore the proper diagnosis is never made or made too late. During a recent 3-year period (2009 to 2011) at Baylor University Medical Center at Dallas, 30 patients with acute AD with tear in AA were diagnosed: 23 (77%) were diagnosed clinically and underwent proper urgent operative therapy; the remaining 7 (23%) with AD with tear in AA were not diagnosed until operation (for another condition) or necropsy or retrospectively by review of antemortem computed tomographic scan after death. The number of patients with AD from tear in AA whose cardiac condition was not diagnosed clinically and who died in the hospital but did not have an autopsy is unclear. Because the autopsy rate in most United States hospitals, including Baylor University Medical Center, is now <5%, many cases of AD are probably not diagnosed and thus its frequency is being underestimated. In conclusion, ≥ 7 of 30 patients (23%) with acute AD with a tear in AA were not diagnosed until necropsy or operation (for another condition) or retrospectively by computed tomography during a 3-year period at a large tertiary medical center showing that this condition continues to be underdiagnosed, and when not diagnosed correctly is usually rapidly fatal. Because the autopsy rate today is so low, the percentage not diagnosed clinically is probably >23%.
Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas, USA. wc.roberts@baylorhealth.edu
William Clifford
WC
Roberts
Travis James
TJ
Vowels
Jong Mi
JM
Ko
Joseph Manuel
JM
Guileyardo
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000293:injuries*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001344:Autopsy; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D015331:Cohort Studies; D057210:Delayed Diagnosis; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States