Acute aortic syndromes

Aortic Dissection claims and delayed diagnosis.

Expert witness reports on missed or delayed diagnosis of type A and type B aortic dissection — often presenting as acute chest or back pain, and a recurrent theme in fatal claims.

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  • Type A & type B dissection
  • Missed aortic dissection report
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what we cover

The condition and the legal questions it raises.

Aortic dissection is a life-threatening separation of the aortic wall layers, typically presenting with sudden-onset chest or interscapular pain. Immediate imaging — CT aortography or transoesophageal echocardiography — is the accepted standard. Delayed diagnosis or misattribution to non-aortic causes frequently leads to catastrophic haemorrhage, tamponade or malperfusion.

Most instructions arise where the diagnosis was missed in the emergency department, where pain was misattributed to a musculoskeletal or gastrointestinal cause, or where imaging was not requested despite a suggestive history. The decisions are tested against NICE CG180 and the ESC acute aortic syndrome guidance.

  • Breach questions address pain assessment, D-dimer interpretation, chest X-ray findings, and the threshold for urgent CT aortography or cardiology referral.
  • Causation questions turn on whether earlier diagnosis would have led to timely surgical repair or medical management, and whether that would, on the balance of probabilities, have prevented fatal haemorrhage or irreversible malperfusion.
  • Fatal claims often involve Article 2 inquests, where the report must address whether the death was preventable.
  • Apportionment arises where a pre-existing aortic aneurysm or connective tissue disorder contributed to the dissection alongside the alleged breach.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether the presenting pain history — sudden onset, tearing, radiating to the back — was assessed for features consistent with acute aortic syndrome.
  • Whether chest X-ray, D-dimer or bedside echocardiography were appropriately requested and acted on, in line with the ESC acute aortic syndrome guidance.
  • Whether the threshold for urgent CT aortography or cardiology referral was met and acted on within the appropriate timeframe.
  • Whether, on the balance of probabilities, earlier diagnosis would have altered the surgical or medical management trajectory.
  • Whether the dissection was type A or type B, and whether the management plan was appropriate for that classification.
Out of scope

Not covered without separate instruction

  • Surgical technique during aortic repair, which sits with cardiac surgery instruction.
  • Cardiothoracic surgical decisions on the timing or approach to repair, addressed via cardiac surgery instruction.
  • Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
  • Quantum, life expectancy and care needs, addressed through dedicated reports where the case progresses to that stage.
Common cases

Common scenarios we report on.

These patterns recur in aortic dissection claims, most turning on emergency department triage or primary care assessment.

  • A&E · Triage

    Sudden back pain misattributed to musculoskeletal cause

    Patient presented to A&E with sudden-onset interscapular pain described as tearing. Symptoms were attributed to musculoskeletal strain without D-dimer or CT aortography, and a type A dissection progressed to fatal tamponade within hours. The report addresses whether the history described classic aortic dissection and whether the imaging threshold was met.

    Often paired with: Breach of Duty Causation

  • A&E · Imaging

    Type A dissection missed on chest X-ray

    A widened mediastinum was visible on chest X-ray; the patient was discharged without CT aortography, and a type A dissection progressed to haemorrhagic shock. The report examines whether the X-ray findings warranted immediate cross-sectional imaging per NICE CG180.

    Often paired with: Breach of Duty Causation

  • Primary care · Referral

    Delayed referral for known aortic aneurysm

    A patient with a known 5.5 cm ascending aortic aneurysm presented to the GP with new chest pain. Urgent cardiology referral was not made, and a dissection followed within days. The report addresses whether the referral threshold was met and whether earlier surgical assessment would have altered the outcome.

    Often paired with: Screening & Merits Breach of Duty

  • Fatal · Article 2

    Type A dissection — delayed diagnosis in fatal claim

    The patient collapsed at home; paramedics recorded chest pain and hypotension. The A&E assessment focused on ACS without CT aortography, and a type A dissection was confirmed post-mortem. The report tests whether earlier diagnosis would have permitted surgical salvage, for the purposes of the inquest.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with causation and fatal-outcome reports often central.

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