Computer tomography imaging for suspected acute aortic syndrome

Acute Aortic Syndrome (AAS) is a life-threatening condition that presents diagnostic challenges due to variable clinical presentations. Limited data exists regarding Computed Tomography Angiography (CTA) utilisation patterns and outcomes for patients with suspected AAS in Irish emergency departments (ED). This study evaluates trends in CTA utilisation and positivity rate for patients with suspected AAS presenting to a level 4 hospital ED.

A retrospective single-centre chart review was conducted of all adult patients (≥ 16 years) who underwent CTA aorta imaging requested by emergency medicine physicians in Tallaght University Hospital between January 2018 and December 2025. Patient demographics, imaging findings, time metrics, disposition and mortality were analysed.

Among 457,735 ED attendances, 797 eligible CTA aorta studies were performed. There was a 2.86 fold increase in CTA scans done across the study period from 37 studies in 2018 to 106 in 2025. Overall positivity rate for AAS was 2.76% (n = 22). Acute aortic dissection accounted for 77% of positive cases (n = 17), followed by penetrating atherosclerotic ulcers (n = 3) and intramural hematomas (n = 2). Overall mortality among patients with confirmed AAS was 27.27%.

This study highlights the low positivity rate of CTA aorta scans in an Irish ED but high mortality of patients diagnosed with acute aortic syndrome. Increasing CTA utilisation, alongside the overall low incidence of AAS, suggests opportunities to improve diagnostic efficiency.