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Journal of Endovascular Therapy : An... Aug 2014To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses.
METHODS
A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990.
RESULTS
Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively.
CONCLUSION
The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Diagnosis, Differential; Diagnostic Errors; Humans; Predictive Value of Tests; Prognosis
PubMed: 25101588
DOI: 10.1583/13-4626MR.1 -
Annals of Emergency Medicine Apr 1992Blunt abdominal aortic rupture is a rare and almost invariably fatal injury that usually occurs as a consequence of motor vehicle accidents. The case of a patient who...
Blunt abdominal aortic rupture is a rare and almost invariably fatal injury that usually occurs as a consequence of motor vehicle accidents. The case of a patient who sustained a nonfatal abdominal aortic rupture while playing soccer is reported. This is the third nonfatal case to be described and the first as the result of a sporting injury.
Topics: Adult; Aorta, Abdominal; Aortic Rupture; Glasgow Coma Scale; Humans; Male; Soccer
PubMed: 1554183
DOI: 10.1016/s0196-0644(05)82664-2 -
The Canadian Veterinary Journal = La... Jun 1973
Topics: Animals; Aorta; Aortic Rupture; Female; Male; Poultry Diseases; Turkeys
PubMed: 4711497
DOI: No ID Found -
The Annals of Thoracic Surgery Apr 1999Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia.
BACKGROUND
Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia.
METHODS
The charts of 263 patients with traumatic aortic rupture from vehicular accidents treated between 1971 and 1998 were reviewed. Patients were grouped according to four periods: group 1, 1971 to 1975, (n = 31); group 2, 1976 to 1985, (n = 83); group 3, 1986 to 1994, (n = 82); and group 4, 1994 to 1998 (n = 67). Seventy-one patients died of exsanguination before definitive care. One hundred-ninety two patients had surgical repair with the following techniques: clamp and sew, 6 in group 1, 22 in group 2, 54 in group 3, none in group 4; shunt, 23 in group 1, 39 in group 2, 2 in group 3; cardiopulmonary bypass, 2 in group 1, 1 in group 3. Forty-three patients had partial bypass with the centrifugal pump and heparin-coated circuits in group 4.
RESULTS
Operative mortality was 6 of 31 (19%) in group 1, 22 of 61 (36%) in group 2, 15 of 57 (26%) in group 3, and 7 of 43 (16%) in group 4. There was one case of paraplegia in group 1 (4%), ten in group 2 (18%), 11 in group 3 (26%), and none in group 4. This difference of paraplegia between the groups was significant (p<0.002). Significant factors for paraplegia were intraoperative hypotension (p<0.000002), cross-clamp time longer than 30 minutes (p<0.008), pump versus no pump (p<0.008), and younger age group (28+/-11 versus 39+/-17 years) (p<0.03).
CONCLUSIONS
There were no statistically significant improvements in mortality rate over the four periods, although, the mortality rate was lowest in the last period when partial bypass with the centrifugal pump was used exclusively. Further, the use of the centrifugal pump with heparin-coated circuits, with femoral vein cannulation into the right atrium and distal aortic perfusion, reduced paraplegia significantly.
Topics: Accidents, Traffic; Aorta, Thoracic; Aortic Rupture; Cardiopulmonary Bypass; Extracorporeal Circulation; Hemorrhage; Humans; Paraplegia; Wounds, Nonpenetrating
PubMed: 10320235
DOI: 10.1016/s0003-4975(99)00174-5 -
Journal of Comparative Pathology 2016Rupture of the aorta is much more common in Friesians compared with other breeds of horse. Rupture always occurs adjacent to the scar of the ligamentum arteriosum....
Rupture of the aorta is much more common in Friesians compared with other breeds of horse. Rupture always occurs adjacent to the scar of the ligamentum arteriosum. Previous histological examination of ruptured aortic walls suggested the presence of an underlying connective tissue disorder. Therefore, the aim of the present study was to compare the structural characteristics of the tunica media of the mid-thoracic aorta, distant to the lesion, in warmblood and Friesian horses with and without thoracic aortic rupture. In unaffected Friesian horses, the thickness of the tunica media, as well as the percentage area comprised of collagen type I, were significantly higher compared with the warmblood horses, supporting the hypothesis of a primary collagen disorder in the Friesian horse breed. However, in the tunica media of the affected Friesian horses there was no significant wall thickening. Moreover, the percentage area comprised of elastin was significantly lower, while the percentage area comprised of smooth muscle was higher, compared with unaffected Friesian and warmblood horses. These lesions are suggestive of an additional mild elastin deficiency with compensatory smooth muscle cell hypertrophy in affected Friesians.
Topics: Animals; Aorta, Thoracic; Aortic Rupture; Horse Diseases; Horses
PubMed: 26987511
DOI: 10.1016/j.jcpa.2016.02.001 -
The Journal of Emergency Medicine Aug 2016Terminology and classifications are the vehicles by which pathologic conditions are identified and understood. It is critically important for the patient admitted with... (Review)
Review
BACKGROUND
Terminology and classifications are the vehicles by which pathologic conditions are identified and understood. It is critically important for the patient admitted with suspected blunt thoracic aortic injury that admitting physicians have a thorough knowledge of acute traumatic aortic tear and its natural history.
OBJECTIVES
The objectives of this review were as follows: (1) to introduce a pathology-based terminology and classification of acute traumatic aortic injuries that unambiguously defines each, and (2) to emphasize the clinical relevance of acute traumatic tear to post-hospital admission deaths in blunt thoracoabdominally injured patients.
METHODS
This is a literature review of 32 refereed articles pertaining to acute traumatic thoracic aortic injury published from 1957 to the present.
RESULTS
The terminology used to describe aortic injury is inconsistent. Several terms are often loosely interchanged: tear, laceration, transection, and rupture. Furthermore, classifications of aortic injuries have been proposed based on microscopic or gross pathologic or computed tomography scan results. While microscopically-based classifications have little or no clinical application, a classification based on gross pathology provides information useful for aortic injury prognosis and management.
CONCLUSION
Reduction of post-hospital death caused by acute aortic tear requires knowledge and understanding of the pathology of acute traumatic aortic tear and its natural history. Such understanding of pathology of acute traumatic aortic tear and its natural history is enhanced by terminology that defines the aortic injury. Therefore, we present our proposed terminology and classification of acute traumatic injuries.
Topics: Aorta; Aortic Rupture; Computed Tomography Angiography; Hospital Mortality; Humans; Terminology as Topic
PubMed: 27156490
DOI: 10.1016/j.jemermed.2016.03.036 -
Radiology Jan 1992Traumatic aortic rupture is a lethal injury that requires immediate diagnosis and surgical repair. The authors report a case of acute aortic rupture in which aortography...
Traumatic aortic rupture is a lethal injury that requires immediate diagnosis and surgical repair. The authors report a case of acute aortic rupture in which aortography demonstrated a subtle intimal discontinuity at the cephalic margin of the aortic spindle. Intravascular ultrasound (US) imaging of the aorta demonstrated a mural flap and a small, contained hematoma. Intravascular US may have a role in enabling confirmation or clarification of subtle aortic abnormalities.
Topics: Adult; Aorta, Thoracic; Aortic Rupture; Aortography; Humans; Male; Ultrasonography; Wounds, Nonpenetrating
PubMed: 1727291
DOI: 10.1148/radiology.182.1.1727291 -
The New England Journal of Medicine Mar 1969
Topics: Anus Diseases; Aorta, Abdominal; Aortic Aneurysm; Aortic Rupture; Hematoma; Humans; Male; Mesocolon; Middle Aged
PubMed: 5764454
DOI: 10.1056/NEJM196903062801007 -
Annali Italiani Di Chirurgia 2009Lesions of the isthmus are the most frequent among post-traumatic lesions of the thoracic aorta (LTA): almost always secondary to closed thoracic traumas (road... (Review)
Review
Lesions of the isthmus are the most frequent among post-traumatic lesions of the thoracic aorta (LTA): almost always secondary to closed thoracic traumas (road accidents, falls, crushing, and explosions), they are rarely iatrogenic (operatory catheterisms) or caused by penetrating wounds. In the review of the literature concerned in the report, from the analysis of 89 bibliographic sources, we note that the etiopathogenesis and the pathophysiology of the LTA still entail a very high immediate mortality, but we also note that, in recent years, remarkable improvements have been made not only in prevention, first-aid, diagnostic definition and in the understanding of the development of the LTA, but above all in therapeutic results. The correct use of the conservative approach, particularly in the immediately post-traumatic phases, the increasingly wide-spread use of endovascular exclusion (T-EVAR), even if not without numerous technical difficulties, and the further improvement of open surgery, currently make it possible to guarantee the individual patient the treatment that can offer the best probabilities of success, at least immediately. Final development, and a more complete and rigorous assessment of the medium and long term results of TEVAR will allow the formulation of therapeutic strategies that are even better defined and increasingly simple to implement, on the basis of algorithms, such as the one proposed by the Authors.
Topics: Algorithms; Aorta, Thoracic; Aortic Rupture; First Aid; Humans; Injury Severity Score; Prognosis; Radiography; Treatment Outcome; Vascular Surgical Procedures
PubMed: 19681289
DOI: No ID Found -
Journal of Vascular Surgery Dec 2022
Topics: Humans; Aortic Rupture
PubMed: 36410845
DOI: 10.1016/j.jvs.2022.06.028