Failure to Diagnose Aortic Dissection in NY Emergency Rooms

What Is Aortic Dissection?

Aortic dissection occurs when a tear develops in the intima -- the innermost layer of the aortic wall. Blood enters the tear and splits (dissects) the aortic wall, creating a false channel (false lumen) for blood flow. This can block blood flow to vital organs (brain, heart, kidneys, intestines, spinal cord, limbs) and can cause the aorta to rupture, leading to sudden death.

There are two main types of aortic dissection, classified by the Stanford system:

• Stanford Type A: Involves the ascending aorta (the portion closest to the heart). This is a surgical emergency requiring immediate repair. Without surgery, mortality is extremely high.
• Stanford Type B: Involves the descending aorta (the portion further from the heart). This is typically managed medically (blood pressure control) unless complications develop, in which case endovascular or surgical intervention may be needed.

Why Aortic Dissection Is Frequently Misdiagnosed

Aortic dissection is frequently misdiagnosed in the emergency department for several reasons:

• Rare condition: Aortic dissection is relatively rare (approximately 5-30 cases per million people per year), compared to heart attack (millions per year). Emergency physicians see far more heart attacks than dissections, which can lead to anchoring bias.
• Symptoms mimic more common conditions: The most common symptom -- sudden, severe chest pain -- is also the hallmark of heart attack. Other symptoms (back pain, abdominal pain, leg pain) mimic more common conditions.
• Atypical presentations: Some patients present without the classic tearing chest pain. They may have isolated back pain, abdominal pain, neurologic symptoms (stroke), or no pain at all.
• Normal EKG and troponin: The EKG may be normal or show nonspecific changes. Troponin (cardiac enzyme) may be normal, particularly early in the presentation. This can lead the physician to dismiss the possibility of a serious condition.
• Normal chest X-ray: While a widened mediastinum on chest X-ray is a classic sign of aortic dissection, it is absent in up to 40% of cases. A normal chest X-ray does not rule out dissection.
• Failure to consider the diagnosis: The most common reason for misdiagnosis is simply failure to include aortic dissection in the differential diagnosis. If the physician does not consider it, they will not order the definitive test (CT angiography).
• Failure to obtain a CT angiogram: The definitive diagnostic test for aortic dissection is CT angiography (CTA) of the chest and abdomen. Failure to order a CTA when the clinical picture is concerning can delay diagnosis with fatal consequences. [Link to: /radiology-errors/ct-scan-negligence]

Common Misdiagnoses

Aortic dissection is commonly misdiagnosed as:

• Acute myocardial infarction (heart attack): Both conditions cause sudden, severe chest pain. However, dissection pain is typically described as tearing or ripping and may radiate to the back, while heart attack pain is typically described as pressure or squeezing and may radiate to the left arm or jaw. [Link to: /medical-malpractice/heart-attack-misdiagnosis]
• Musculoskeletal chest pain: The pain is attributed to muscle strain or costochondritis, and the patient is discharged.
• Gastrointestinal illness: If the dissection involves the abdominal aorta, it can cause abdominal pain that is attributed to gastroenteritis, pancreatitis, or bowel obstruction.
• Stroke: If the dissection involves the carotid arteries, it can cause neurologic symptoms (weakness, speech difficulty) that are attributed to stroke -- without recognizing that the stroke is caused by the dissection. [Link to: /medical-malpractice/stroke-misdiagnosis]
• Pulmonary embolism: Chest pain and shortness of breath can be attributed to pulmonary embolism. [Link to: /misdiagnosis/pulmonary-embolism-misdiagnosis]
• Back pain (nonspecific): Dissection pain that radiates to the back is attributed to musculoskeletal back pain or kidney stones.

The Standard of Care for Aortic Dissection

The standard of care for evaluating a patient with suspected aortic dissection in the emergency department includes:

• Thorough history and physical examination: Including assessment of pain quality (tearing, ripping), radiation (to the back), and associated symptoms (neurologic deficits, syncope, pulse deficits, blood pressure differential between arms).
• Risk factor assessment: Including hypertension (the most common risk factor), connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome), bicuspid aortic valve, prior aortic surgery, family history of aortic disease, and cocaine use.
• EKG: To evaluate for heart attack (which can coexist with dissection).
• Chest X-ray: To look for a widened mediastinum (present in up to 60% of cases) -- but a normal chest X-ray does not rule out dissection.
• CT angiography (CTA): The definitive diagnostic test. The standard of care requires ordering a CTA when the clinical picture is concerning for dissection. [Link to: /radiology-errors/ct-scan-negligence]
• Blood pressure control: If dissection is suspected, blood pressure should be controlled aggressively (beta-blockers) to reduce the shear stress on the aortic wall.
• Cardiothoracic surgery consultation: For Type A dissection, immediate cardiothoracic surgery consultation is required. [Link to: /surgical-errors/cardiac-surgery-malpractice]

When Misdiagnosis Constitutes Malpractice

A failure to diagnose aortic dissection constitutes medical malpractice in New York when a healthcare provider deviated from the accepted standard of care and that deviation caused harm. This includes:

• The ER physician failed to include aortic dissection in the differential diagnosis for a patient with concerning symptoms.
• The ER physician failed to obtain a thorough history and physical examination (including assessment of pain quality, radiation, pulse deficits, and blood pressure differential).
• The ER physician failed to order a CT angiogram when the clinical picture was concerning for dissection. [Link to: /delayed-diagnosis-lawyer/failure-to-order-tests]
• The ER physician prematurely diagnosed the patient with a less serious condition (heart attack, musculoskeletal pain, GI illness) without ruling out dissection. [Link to: /medical-malpractice/premature-discharge-unsafe-discharge]
• The radiologist misread the CT angiogram. [Link to: /radiology-errors/ct-scan-negligence]
• The ER physician failed to control blood pressure while awaiting definitive diagnosis.
• The ER physician failed to obtain immediate cardiothoracic surgery consultation for a Type A dissection.
• The deviation caused harm (the delay in diagnosis caused the dissection to progress, rupture, or compromise blood flow to vital organs, causing death or permanent disability).

Proving Your Aortic Dissection Misdiagnosis Case

To prove an aortic dissection misdiagnosis case, we:

• Obtain medical records: Including ER physician notes, nursing notes, vital signs (including blood pressure in both arms), EKG, chest X-ray report, CT angiogram report (if ordered), lab results, and discharge instructions. [Link to: /resources/how-to-get-medical-records-for-a-lawsuit]
• Obtain EMS records: If the patient arrived by ambulance, the EMS run sheet provides valuable information about the patient initial symptoms and vital signs.
• Obtain radiology images and reports: We obtain the actual CT angiogram images and have them independently reviewed by a board-certified radiologist. [Link to: /radiology-errors/ct-scan-negligence]
• Engage expert review: We work with board-certified emergency medicine physicians, cardiologists, cardiothoracic surgeons, and radiologists to independently review your records.
• Establish the standard of care: We determine what the standard of care requires for evaluation of suspected aortic dissection.
• Establish causation: We prove that earlier diagnosis and treatment would have changed the outcome (e.g., that emergency surgery for a Type A dissection would have prevented rupture or death). [Link to: /delayed-diagnosis-lawyer/loss-of-chance]

New York Statute of Limitations

Aortic dissection misdiagnosis claims are subject to the 2.5-year statute of limitations for medical malpractice (CPLR 214-a), running from the date of the negligent act. However, Lavern Law may apply if the misdiagnosis involves cancer or a malignant tumor (aortic dissection itself is not cancer, so Lavern Law generally does not apply).

Key considerations:

• Date of the negligent act: The 2.5-year clock starts on the date of the ER visit where the misdiagnosis occurred.
• Continuous treatment doctrine: If you continued to receive treatment from the same hospital/provider for the same condition, the statute may be extended.
• Municipal hospitals: If the error occurred at a municipal hospital (NYC Health + Hospitals), a notice of claim must be filed within 90 days under General Municipal Law Section 50-e. [Link to: /hospital-negligence/suing-nyc-h-h] [Link to: /wrongful-death/notice-of-claim-nyc]
• Wrongful death: If the misdiagnosis caused death, the wrongful death claim must be filed within 2 years. [Link to: /wrongful-death-lawyer]

Common Defense Arguments and How We Counter Them

Defense: Aortic dissection is rare and difficult to diagnose.

Defense attorneys use several arguments in aortic dissection misdiagnosis cases:

• Our Counter: While aortic dissection is rare, the standard of care requires emergency physicians to include it in the differential diagnosis for any patient with concerning symptoms (sudden, severe chest pain, tearing pain, back pain, pulse deficits, blood pressure differential). The standard of care does not require the physician to make the diagnosis immediately -- it requires them to order the definitive test (CT angiography) when the clinical picture is concerning.

Defense: The patient symptoms were atypical.

Our Counter: While some patients present atypically, the standard of care requires the physician to consider the full range of possible diagnoses and to order appropriate tests. If the patient had risk factors (hypertension, connective tissue disorder) or concerning symptoms (sudden, severe chest or back pain), the standard of care required ordering a CT angiogram.

Defense: The patient was having a heart attack, which justified the workup.

Our Counter: Heart attack and aortic dissection can coexist (in fact, a Type A dissection can cause a heart attack by compromising the coronary arteries). The standard of care requires the physician to evaluate for both conditions. If the patient had symptoms concerning for dissection (tearing pain, back pain, pulse deficits), the standard of care required ordering a CT angiogram in addition to the cardiac workup.

Defense: The delay did not cause the harm.

Our Counter: We use expert testimony from cardiothoracic surgeons and emergency medicine physicians to establish that earlier diagnosis and treatment would have changed the outcome. For Type A dissection, we establish that emergency surgery would have prevented rupture or death. [Link to: /delayed-diagnosis-lawyer/loss-of-chance]

Compensation Available

A successful aortic dissection misdiagnosis claim in New York can provide compensation for:

• Medical expenses: Including past and future medical care, surgeries, rehabilitation, and medications
• Lost wages and lost earning capacity: For time missed from work and reduced ability to work
• Pain and suffering: NY has no cap on non-economic damages
• Permanent disability: For brain damage (from reduced blood flow to the brain), spinal cord injury (from reduced blood flow to the spinal cord), organ damage, and other permanent conditions [Link to: /brain-injury/lawyer] [Link to: /spinal-cord-injury/lawyer]
• Future medical care costs: Based on a life care plan, discounted to present value
• Loss of consortium: For the impact on family relationships
• Wrongful death damages: If the misdiagnosis caused death [Link to: /wrongful-death-lawyer]

What to Expect Working with MDLaw Firm

When you contact MDLaw Firm about a potential aortic dissection misdiagnosis case:

• Free Consultation: We listen to your story and review the basic facts.
• Immediate Deadline Assessment: We evaluate the 2.5-year statute of limitations and any municipal notice of claim deadlines.
• Record Retrieval: We obtain all medical records, including ER physician notes, vital signs, EKG, chest X-ray, CT angiogram images and reports, and discharge instructions. [Link to: /resources/how-to-get-medical-records-for-a-lawsuit]
• Expert Review: We engage board-certified emergency medicine physicians, cardiologists, cardiothoracic surgeons, and radiologists to independently review the records.
• Causation Analysis: We establish that earlier diagnosis and treatment would have changed the outcome.
• Life Care Plan: If the injury is permanent, we engage a life care planner to project future care needs. [Link to: /brain-injury/life-care-plan]
• Litigation: We file within the statute of limitations and handle all aspects of discovery and trial.
• Resolution: We pursue maximum compensation through settlement or verdict.

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.