Chest Radiography Should Not Be Used to Rule out Acute Aortic Syndromes

The diagnosis of acute aortic syndromes (AAS) such as aortic dissection typically relies on computed tomographic (CT) angiography. Given the low incidence but high-risk nature of these diseases, clinicians strive to risk-stratify emergency department (ED) patients to avoid excessive and unnecessary CT angiography in low-risk patients. Chest radiography (CXR) is often used as an initial screening test.

In this retrospective analysis, researchers assessed the utility of CXR in the diagnosis of AAS in about 1000 patients presenting to the ED. The Aortic Dissection Detection Risk Score was used to risk-stratify patients. Radiologists reviewed the CXRs for widened mediastinum, left apical opacity, and other features associated with AAS; attending…