Why do Doctors miss Aortic Dissections?

Aortic dissection is a rare but serious condition that can be difficult to diagnose in the emergency room (ED). This is because its symptoms can overlap with other conditions, and it can present in a variety of ways:

Symptoms overlap

Aortic dissection's symptoms can mimic other conditions, such as acute coronary syndrome, pulmonary embolism, heart failure, and stroke.

Symptoms vary

Symptoms can vary in severity and presentation, and up to 17% of patients with acute aortic dissection don't experience pain at all.

Physical exam

Classic physical exam findings are present in less than a third of cases, and a patient with acute aortic dissection may have a normal exam.

Imaging

Aortic dissection can't be reliably seen on a simple x-ray.

Some ways to improve diagnosis include:

Taking a more comprehensive history

Using more imaging, such as a computed tomography (CT) scan with contrast , echocardiography, or MRI

Considering aortic dissection as a differential diagnosis, even for patients with mild symptoms

Educating clinicians on which patients to consider for aortic dissection

Once diagnosed, treatment for aortic dissection involves blood pressure control, analgesia, and urgent surgery or transfer.

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