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Updated: Jun 23, 2026
07:12
An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
Does this patient have an acute thoracic aortic dissection?
1Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. mklompas@partners.org
JAMA
|May 1, 2002
Summary
Diagnosing acute thoracic aortic dissection is challenging. While sudden severe pain and specific physical exam findings like pulse deficits increase suspicion, they are not always present, making clinical diagnosis difficult.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Acute thoracic aortic dissection is a life-threatening condition with diagnostic challenges.
- Delayed diagnosis of aortic dissection leads to increased morbidity and mortality.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clinical history, physical examination, and chest radiography for acute thoracic aortic dissection.
- To identify key clinical indicators that aid in the diagnosis of thoracic aortic dissection.
Main Methods:
- A comprehensive literature review of English-language studies from 1966-2000 was performed using MEDLINE.
- Included studies focused on clinical findings in consecutive patients with confirmed thoracic aortic dissection.
- Twenty-one relevant studies were selected based on predefined quality and inclusion criteria.
Main Results:
- Sudden severe pain (90% sensitivity) and sudden onset (84% sensitivity) are common in thoracic aortic dissection.
- Physical findings like pulse deficits (LR 5.7) and neurological deficits (LR 6.6-33.0) significantly increase suspicion.
- A normal chest radiograph (negative LR 0.3) or absence of sudden pain lowers the probability of dissection.
Conclusions:
- Pulse deficits, neurological deficits, and sudden severe pain are crucial indicators for acute thoracic aortic dissection.
- A normal chest radiograph or lack of sudden pain can decrease the likelihood of dissection.
- Clinical examination alone is insufficient to rule out aortic dissection due to its low sensitivity and high risk of missed diagnosis.
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