When present, the finding of a widened mediastinum was associated with TAD/TAA, as previously reported [29]. Because a widened click here mediastinum is difficult to interpret
on a portable x-ray, a formal standing posterior-anterior chest x-ray for patients presenting with chest pain may be necessary. CT scanning is an effective screening modality [30] but cannot be utilized for all patients with acute thoracic complaints who present to busy ED’s. Transthoracic echocardiography may also a useful imaging modality for the diagnosis of acute aortic syndromes. Some have reported it to be beneficial for screening [31] but it should not be used as the sole screening imaging technique [32]. Limitations of the study include the retrospective nature of the study design. A larger cohort of patients that presented with acute thoracic symptoms but were not found to have acute thoracic aortic dissection or aneurysm would have provided a statistically enhanced database to allow for the development of a risk prediction model. Such modeling would facilitate the use of the findings reported herein. In addition examining the missed diagnosis rate and delay in diagnosis in a prospective fashion using this model
would validate the findings from this study. Screening patients with acute chest pain in the emergency department for thoracic aortic dissection or thoracic aortic aneurysm presents a clinical challenge. In the current study, we GNS-1480 identified increasing
heart rate, presence of chest pain, head and neck pain, dizziness, selleck chemicals llc diabetes, and history of myocardial infarction to be independently associated with ACS as opposed to TAA/TAD. These represent easily obtainable factors that can be used to screen patients to undergo prompt confirmatory imaging with CT of the chest. Acknowledgments This has been presented at the Eighth Annual Academic Surgical Congress in Feb, 2013. References 1. Woo KM, Schneider JI: High-risk chief complaints I: chest pain-the big three. Emerg Med Clin North Am 2009,27(4):685–712.PubMedCrossRef 2. Assar AN, Zarins CK: Ruptured abdominal aortic aneurysm: Avelestat (AZD9668) a surgical emergency with many clinical presentations. Postgrad Med J 2009, 85:268–273.PubMedCrossRef 3. Mehta RH, Suzuki T, Hagan PG, et al.: Predicting death in patients with acute type a aortic dissection. Circulation 2002,105(2):200–206.PubMedCrossRef 4. Klompas M: Does this patient have an acute thoracic aortic dissection? JAMA 2002,287(17):2262–2272.PubMedCrossRef 5. Booher AM, Isselbacher EM, Nienaber CA, et al.: The IRAD classification system for characterizing survival after aortic dissection. Am J Med 2013,126(8):730.PubMedCrossRef 6. Ramanath VS, Oh JK, Sundt TM, et al.: Acute aortic syndromes and thoracic aortic aneurysm.