Three cases of diagnostic delay of type A acute aortic dissection
Takeshi Shimamoto1, Sanae Tomotsuka2, Makoto Takehara2
1Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Hamamatsu, Shizuoka, 430-8525, Japan. takeshishimamoto@hamamatsuh.johas.go.jp.
Insights
Diagnostic delay in type A acute aortic dissection (TAAAD) is a critical issue. This report details three cases where delayed diagnosis of TAAAD led to adverse outcomes, highlighting the need for improved diagnostic accuracy.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Diagnostic delay (DD) poses a significant risk to patients with type A acute aortic dissection (TAAAD).
- Prompt diagnosis and intervention are crucial for TAAA survival.
- This study examines three distinct cases of DD in TAAA patients.
Purpose of the Study:
- To illustrate the commonality and multifactorial nature of diagnostic delays in TAAA.
- To emphasize the critical need for enhanced diagnostic accuracy in TAAA cases.
- To review clinical scenarios contributing to TAAA diagnostic delays.
Main Methods:
- Retrospective case series analysis of three TAAA patients.
- Review of clinical presentations, diagnostic imaging (CT scans), and healthcare encounters.
- Analysis of factors contributing to diagnostic delays in each case.
Main Results:
- Case 1: Initial suspicion of TAAA with thrombosed false lumen overlooked, leading to delayed diagnosis.
- Case 2: Displaced intimal flap in aortic arch CT scan missed by a physician nearing shift end.
- Case 3: TAAA diagnosis delayed due to lack of insurance and initial misdiagnosis as back pain.
Conclusions:
- Diagnostic delays in TAAA are frequent and stem from various factors.
- Improved communication between radiology and clinical teams is essential.
- Vigilance and comprehensive evaluation are paramount for timely TAAA diagnosis.
Background:
Diagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD.
Case Presentation:
Case 1 is a female in her sixties presenting with severe back pain. A CT scan was taken, and TAAAD with a thrombosed false lumen was suspected by the radiology technician. He did not successfully transfer his concern to the physicians and the patient was sent home. The next day, she was transferred to another hospital with a recurrence of the symptom, and the diagnosis of TAAAD was made with a CT scan there. Case 2 was an 87-year-old female who was transferred to our hospital because of a loss of consciousness and bruises on the forehead. CT scan was taken and the displaced intimal flap in her aortic arch was overlooked by the part-time physician almost at the end of his shift. The diagnosis of TAAAD was made by the radiologist. Case 3 was the 44-year-old male who did not have health insurance and experienced severe back pain a few days before the visit to our clinic. On that day, he went to the nearby hospital's emergency room, and only pain medication was prescribed. A few days later, a CT scan was taken at our hospital to investigate the cause of pyuria and the diagnosis of TAAAD was made.
Conclusion:
DD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy.
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