A Clinical Investigation Of 335 Cases Of Misdiagnosed Aortic Dissection

Objective: To study the present situation of misdiagnosed aortic dissection (AD) in China and to improve the consciousness with aortic dissection. Methods: Through searching www.cnki.net, 52 documents of Chinese-language cases involving the misdiagnosed AD published from January 1995 to December 2004 were identified by document-study method. Retrospective survey study of misdiagnosed diseases, clinical manifestations and accessory examinations was made in 335 patients with aortic dissection. The relationship between clinical symptoms and the type of AD were analyzed by Chi-squared test. Results: The patients with AD have diversific clinical manifestations. The incidence of pain was the highest(85.1%), among which chest-back pain was the first manifestation and abdomen pain was the second. When comparing type A and type B, abdominal pain was more common in the latter than in the former (P<0.05), whereas apopsychia was more common in the former (P<0.01). The misdiagnosed diseases reached 32 kinds. The first five places successively were: coronary heart disease in 144 cases(42.9%); acute abdomen in 57 cases(17.0%); central nerve disease in 15 cases (4.5%); lithangiuria in 14 cases(4.2%), rheumatic heart disease in 13 cases(3.9%). 83 cases(57.6%)were misdiagnosed to angina pectoris and 61 cases(42.4%)were misdiagnosed to myocardial infarction in the first place; In the second place, there were 33 cases(57.9%) misdiagnosed to pancreatitis, 17 cases(29.9%)misdiagnosed to cholelithiasis and/or cholecystitid and 7 cases(12.2%)misdiagnosed to ileus; In the third place, 11 cases(73.3%)were misdiagnosed to stroke and 4 cases(26.7%)were misdiagnosed to myelitis. Conclusion: The manifestations of AD are complicated and no specificity. The misdiagnosis rate in AD is high and the kinds of misdiagnostic diseases are various. Patients who have pain, signs of obstruction of artery, companied with hypertension or not, should be considered to AD. In clinical practice, combining imaging examinations can raise diagnosis rate.