Paucis Verbis: International Registry on Aortic Dissection (IRAD)

What do these three people have in common? 

Lucille Ball (comedienne)

Jonathan Larson (wrote the musical "Rent")

John Ritter (comedian)

They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with aortic dissections.

I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren't actually very common. Here are some scary examples:

• A pulse deficit in the carotid, brachial, and femoral arteries is only present 15% of the time. 
• A tearing or ripping quality of pain is present in only 50% of patients.
• Not all patients have a widened mediastinum or abnormal aortic contour (only 78.7%).

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Reference
Hagan P et al. The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease JAMA. 2000; 283(7), 897-903. DOI: 10.1001/jama.283.7.897
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