Restricting Imaging to Pain Area Provides Highly Sensitive Approach to Ruling Out AAS

Background: Acute aortic syndrome (AAS) is a life-threatening condition, including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer, and timely and accurate diagnosis is critical. Current imaging recommendations include CT of the entire aorta even though 98% of these studies are negative. Also, about 20% of these negative scans result in nonsignificant incidental findings, which lead to further imaging and follow-up. Since most cases of AAS present with pain due to focal damage of the aortic wall and ischemia to adjacent organs, restricting imaging to the area of pain could increase imaging sensitivity with the added benefit of reduced radiation exposure, image acquisition/reading time, and nonsignificant incidental findings. Objective: To evaluate whether restricting imaging to the area of aortic-related pain accurately rules out AAS. Design: Retrospective health record review study. Methods: Consecutive cases from 3 academic emergency departments (EDs) more...