Aortic dissection: effect of prospective chest radiographic diagnosis on delay to definitive diagnosis

To determine the effect of the interpretation of plain chest radiographs on the time to definitive diagnosis of aortic dissection.

The authors evaluated chest radiographs from 75 patients in whom chest radiography was performed before aortic dissection was diagnosed. The radiographs and available comparison images were retrospectively reviewed to identify cases in which aortic dissection should have been suggested before the diagnosis was made.

Radiographic reports suggested that only 19 patients (25%) had an aortic dissection or thoracic aortic aneurysm or needed additional imaging of the aorta. No statistically significant correlation existed between interpretation of the chest radiographs and delay to diagnosis, type of dissection, availability of previously obtained images, or presence of characteristic clinical symptoms. Retrospective analysis showed that the chest radiographs of 36 patients (48%) contained sufficient findings to suggest the diagnosis. In five patients, failure to prospectively suggest dissection was associated with a delay to diagnosis of more than 24 hours.

Although prospective interpretation of the chest radiograph shortened the delay to definitive diagnosis for only a limited number of patients, retrospective analysis suggests that the delay can be shortened for additional patients.