THORACIC AORTIC DISSECTION

Course overview

Over 10,000 Americans each year die of thoracic aortic dissection (TAD). Limited clinical exposure combined with highly variable patient presentations contribute to the potential for delayed or missed diagnoses. Early diagnosis and treatment is challenging but necessary to save lives, improve quality and reduce risk. Failure to diagnose or delay in diagnosis of TAD may result in significant patient morbidity or mortality and exposure to liability for the clinician and hospital. Due to the difficult nature of presentations and the overlap with other presentations of disease (e.g., pneumonia, ACS), it is simply not possible to make the diagnosis in every case. However, practitioners must strive to recognize presentations that are consistent with TAD, evaluate the risk factors for TAD in such patients, and pursue definitive diagnostic testing. In this activity, we focus on the medical and legal issues associated with TAD and present and discuss a number of cases to demonstrate some of the most common reasons the diagnosis of TAD is delayed, missed, or inappropriately managed. After completing this activity, practitioners should be able to: integrate awareness of the reasons for the failure to diagnose TAD into clinical practice in order to improve patient safety, improve documentation and decrease the risk of exposure to medical malpractice; synthesize the key signs and symptoms for patients who present with syncope or a focal neurologic complaint and chest pain in order to establish a comprehensive differential diagnosis and avoid the failure to diagnose TAD; and determine when to order advanced imaging for patients who present with risk factors suggestive of TAD on history and/or examination.