Hong Kong Journal of Emergency Medicine

Volume 9 Number 2, April 2002

Beware of the migrating chest pain and widened mediastinum: case series on aortic dissection

CH Chung and KK Lai

Objective: Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design: Retrospective case review for a period of 3 years and 4 months.
Setting: District general hospital near the Hong Kong - Shenzhen 'border' with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population: All cases coded as 'aortic dissection' in the computerized 'Clinical Management System' of the hospital. Main outcome measures: Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results: From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion: The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition. (Hong Kong j.emerg.med. 2002;9:95-101)

Keywords : Aneurysm, aortic rupture, chest pain, dissecting, mediastinum

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