Diagnostic value of tearing pain alone in aortic dissection

Severe and sudden chest or back pain that feels like tearing is the most common symptom of aortic dissection. This study aimed to investigate if chest or abdominal pain alone is a marker of aortic dissection and to determine its patient characteristics. This was a retrospective, single-center observational study. It was conducted in the emergency department (ED) of a tertiary university hospital in Turkey. During three years, patients admitted to the ED and underwent contrast-enhanced thoracic and abdominal computed tomography angiography (CTA) were detected through the hospital computer system. Patients with tearing chest or abdominal pain at admission were identified. Patients with and without aortic dissection were compared based on gender, triage code, comorbidity, aortic aneurysm, and one-month mortality. 76.3% (n = 730) out of 957 CTAs were performed due to complaints of tearing chest or abdominal pain. Aortic dissection was detected in 4.5% (n = 33) of patients with tearing pain. Pre-existing aortic aneurysm was statistically significantly higher in the dissection group (p < 0.001). When the chest or abdominal pain and CTA findings regarding the presence of aortic dissection were compared, the sensitivity of tearing pain was 84.62%, and the specificity was 24.07%. The positive predictive value of tearing pain was 4.52%, and the negative predictive value was 97.36%. In conclusion, the negative predictive value of tearing pain for aortic dissection was approximately 97%. This severe pain raises the possibility of aortic dissection. However, aortic dissection is only detected in a small percentage of cases in CTAs performed immediately to confirm the diagnosis.

Aortic dissection; Tearing pain; Computed tomography angiography; Emergency department

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