Failure to Diagnose Aortic Dissection: A Case-Screening Guide

Diagnostic error is the largest source of serious medical-malpractice harm: the "Big Three" disease categories — vascular events, infections, and cancers — account for roughly three-quarters of serious misdiagnosis-related harm, an estimated ~795,000 Americans per year suffering death or permanent disability (Newman-Toker et al., BMJ Quality & Safety, 2023–2024). The time-critical emergencies below sit squarely in that group: each has a narrow window in which the right test changes the outcome, which is exactly why a missed one so often becomes a viable case.

Why it's missed

Aortic dissection mimics more common diagnoses — myocardial infarction, musculoskeletal pain, even reflux. The classic teaching of sudden "tearing" chest or back pain is present in only a portion of cases; atypical presentations (syncope, stroke-like deficits, abdominal pain, painless dissection) are common. A patient anchored to a "rule out MI" pathway can be discharged or treated for the wrong thing while the dissection propagates.

What the standard of care generally expects

Where the history and exam raise the possibility, a competent workup typically considers: a focused risk assessment (hypertension, connective-tissue disease, bicuspid valve, pregnancy, cocaine use), bilateral blood-pressure/pulse comparison, chest imaging, and — when suspicion is real — CT angiography (or TEE/MRI where appropriate) rather than reliance on a normal ECG or a single troponin. Documentation that the differential was considered and excluded is itself a key fact. [Confirm the applicable standard with a qualified expert in your venue.]

What makes the case viable

• Breach: a presentation that should have triggered the dissection workup, and a record showing it wasn't done or wasn't documented.
• Causation: a window in which timely diagnosis (surgery / blood-pressure control) would more likely than not have changed the outcome — the central battleground, and expert-dependent.
• Damages: death or catastrophic injury (stroke, organ ischemia, paralysis) drive value.

The records angle

Pull the full ED record including triage vitals, every set of vitals over the stay, the ECG/troponin timing, any imaging ordered or declined, and the discharge instructions. The timing of each entry — and any note entered or amended after the bad outcome — is often where the case turns; the audit trail and a clean chronology surface it.

General information for attorneys, not legal or medical advice. Standard-of-care, causation, and damages rules vary by jurisdiction — verify every standard, statute, and deadline against current authority in your venue, and rely on a qualified medical expert for the clinical analysis.

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