Aortic aneurysms and aortic dissections are often treatable, (especially if found before they blow open). But they are frequently missed by doctors and therefore a common reason for medical malpractice lawsuits.
The aorta delivers freshly oxygenated blood from the heart to the rest of the body. In the chest it rises for a short distance from the top of the heart, then arcs and dips south to supply blood to the abdomen, pelvis, and legs. In the chest it’s called the thoracic aorta, and in the abdomen, naturally, it’s the abdominal aorta.
When the aorta balloons outward because of a weakness in its wall, that’s called an aneurysm. When the aorta develops a tear in the layers of its wall, that’s known as a dissection. Any weakness, rupture or dissection of the aorta anywhere in the chest or abdomen is life-threatening. Aneurysms in the chest are often spotted by an imaging test — typically a CT scan of the chest or even a simple chest X-ray — that is done for some other reason and the bulge in the aorta is seen by an alert radiologist (or missed by a not-so-alert one).
The actor John Ritter died of a dissection of his thoracic aorta. His family brought a medical malpractice lawsuit, which they settled against some defendants. A trial against other defendants resulted in a verdict for the doctors in 2008.
Another prominent person killed by a thoracic aortic dissection was Jonathan Larson, writer of the Broadway musical Rent. He was seen three separate times in an emergency department in New York before he was found dead in his apartment by his roommate at age 35. Mr. Larson presented initially with a complaint of severe chest pain and was diagnosed with food poisoning — despite no symptoms of nausea, vomiting, or diarrhea. His chest x-ray was abnormal but no connection was made to an aorta problem. He later returned with chest and back pain. He was quoted as saying, “You’d better call 911. I think I am having a heart attack.” Too late, Mr. Larson was found to have had Marfans disease, which is often connected with weakness of the aorta.
Dr. Robert Rogers of the University of Maryland has frequently lectured and written about diagnosis of aortic dissection in the chest. He describes several combinations of symptoms that should make emergency doctors think about aortic dissection, including:
- Chest pain and any neurologic symptoms [suspected stroke, leg weakness, inability to swallow, visual disturbances, etc.]
- Chest pain and limb paresthesia [tingling and numbness in an arm or leg]
- Unexplained fainting
- Isolated abdominal pain
- Unexplained leg weakness even without chest pain
One classic medical error he notes is to assume that a patient with multiple symptoms has multiple diseases. The failure to integrate patient symptoms into a single disease often leads to misdiagnosis. As Dr. Rogers wrote:
“There are many case reports of patients presenting with chest pain and lower extremity [leg] weakness. What is striking about these cases is the fact that the chest pain was addressed and the lower extremity symptoms were ignored-i.e. failure to integrate patient complaints. The combination of chest, back pain and extremity weakness/paresthesias should prompt consideration of thoracic artery dissection!” (Emphasis by Dr. Rogers)
An abdominal aortic aneurysm also can be a major threat to life. This happens when the aorta develops a weakness in its wall which then balloons outward. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along an inside wall of the vessel (dissection), symptoms may develop suddenly. Key symptoms of a rupture or dissection can include pain in the abdomen or back — severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs. This pain can mimic the chest pain of a heart attack and result in a misdiagnosis that way, among others.
Famous people who died of a ruptured abdominal aortic aneurysm include: Albert Einstein, Lucille Ball, and Conway Twitty.
Here are some fascinating facts about abdominal aortic aneurysm from Columbia University surgery professor Dr. M. David Tilson.
Patient safety tip for aortic aneurysm
If you have had a close family member diagnosed with an aortic aneurysm, you should consider getting a painless ultrasound test to see if you have one. Repair before it ruptures is a lot more successful than attempted repair after it is torn open. Read more…
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