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The presenting chest roentgenogram in acute type A aortic dissection: a multidisciplinary study.

M Consuelo Gregorio, Fritz J Baumgartner, Bassam O Omari

    The American Surgeon
    |December 7, 2002
    PubMed
    Summary

    Chest X-rays (CXRs) are not reliable for diagnosing acute type A aortic dissection. While abnormal CXRs can raise suspicion, normal results should not delay further diagnostic tests like echocardiography.

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    Area of Science:

    • Cardiology
    • Radiology
    • Emergency Medicine
    • Thoracic Surgery

    Background:

    • Acute type A aortic dissection necessitates rapid diagnosis and surgical intervention.
    • The diagnostic utility of chest roentgenogram (CXR) in identifying acute type A aortic dissection remains uncertain.
    • This study investigates the role of initial CXR in raising suspicion for acute type A aortic dissection.

    Purpose of the Study:

    • To evaluate the impact of initial chest roentgenogram (CXR) findings on physician suspicion for acute type A aortic dissection.
    • To determine if CXR patterns can guide further diagnostic workup for acute aortic dissection.

    Main Methods:

    • Twelve physicians from emergency medicine, radiology, cardiology, and cardiothoracic surgery participated.

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  • Physicians reviewed CXRs from ten patients with acute type A aortic dissection and ten normal individuals in a blinded manner.
  • Evaluations included identifying normal/abnormal CXRs and assessing suspicion for aortic dissection.

    • Main Results:

    • 93% of dissection CXRs were read as abnormal, versus 68% of normal CXRs (P < 0.001).
    • 73% of dissection CXRs were considered suspicious for dissection, while 16% of normal CXRs were incorrectly flagged as suspicious (P < 0.001).
    • Widened mediastinum was the most frequent finding (38%) in dissection CXRs when specifically queried.

    Conclusions:

    • The presenting chest roentgenogram (CXR) demonstrates low sensitivity and specificity for acute type A aortic dissection.
    • In patients with clinical suspicion, CXR findings of mediastinal widening should increase suspicion and prompt further investigation.
    • A normal CXR should not impede timely echocardiography to rule out type A dissection in clinically suspected cases.