Acute aortic dissection: be aware of misdiagnosis.
Acute aortic dissection: be aware of misdiagnosis.
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DOI：
10.1186/1756-0500-2-25
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发表时间：
2009-02-20
影响因子：
1.8
通讯作者：
Asteri T
中科院分区：
文献类型：
--
作者：
Asouhidou I;Asteri T
急性主动脉夹层（AAD）是一种危及生命的疾病，需要立即评估和治疗。患有AAD的患者通常表现出不重要或不相关的病史，导致可能的误诊。这项回顾性研究的目的是解决AD误诊的问题和使用的不同影像学检查。2000年1月至2004年12月，49例患者（男41例，女8例，年龄18-75岁）因不同原因就诊于我院急诊科，最终确诊为抗心律失常。其中15名患者患有动脉高血压，1名患者患有巨细胞动脉炎，另1名患者患有马凡氏综合征。AAD的诊断通过胸部X线、对比增强计算机断层扫描（CT）、经胸超声心动图（TTE）和冠状动脉造影进行。15例患者（31%）发生了最初的误诊，后来发现患有AAD。误诊为心肌梗死12例，脑梗死3例。主动脉夹层可能会出现多种临床表现，如晕厥、胸痛、无尿、脉搏缺损、腹痛、背痛或急性充血性心力衰竭。近三分之一被发现患有AD的患者最初被诊断为其他疾病。急性主动脉夹层的治疗关键是对诊断保持高度怀疑。
Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old) presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT), transthoracic echocardiography (TTE) and coronary angiography. Initial misdiagnosis occurred in fifteen patients (31%) later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients. Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.