Aortic Aneurysm Malpractice

IF YOU ARE HAVING SEVERE CHEST, BACK, OR BELLY PAIN OR IF YOU THINK YOU ARE HAVING A HEART ATTACK OR STROKE, IMMEDIATELY GO TO A HOSPITAL EMERGENCY DEPARTMENT. DO NOT ATTEMPT TO DRIVE YOURSELF. CALL 911 FOR EMERGENCY MEDICAL TRANSPORT.

A dissecting or ruptured aortic aneurysm is a life threatening medical emergency.  Failure to promptly diagnosis and treat these conditions can be fatal.  Timely diagnosis and treat has a good prognosis.

What is an Aneurysm?

Abnormal enlargement or bulging of the aorta, the largest blood vessel of the body, is not an unusual condition. Medical professionals refer to this as aneurysm of the great vessel, or aortic aneurysm. The enlargement usually affects only a small part of the vessel, so bulge is a more accurate description.

An aneurysm occurs when a segment of the vessel becomes weakened. The pressure of the blood flowing through the vessel creates a bulge at the weak spot, much as an over inflated inner tube can cause a bulge in a tire. The bulge usually starts small and grows as the pressure continues. Aneurysms are dangerous because they can rupture, causing internal bleeding.
The aorta is an artery, meaning it carries oxygen-rich blood from the heart. It is the main artery coming from the heart.

• It extends from the left chamber of the heart and goes through the chest, down through the belly or midsection of the body (abdomen), and into the pelvis).
• In the groin, it divides into 2 vessels that supply blood to the lower trunk and both legs.
• In the chest, the aorta is called the thoracic aorta; in the abdomen, the abdominal aorta.

The aorta, the main artery leading away from the heart, can sometimes develop an aneurysm. Aortic aneurysms usually occur in the abdomen below the kidneys (abdominal aneurysm-AAA), but may occur in the chest cavity (thoracic aneurysm- TAA). This can happen if the wall of the aorta becomes weakened by build ups of fatty deposits called plaque. This is called atherosclerosis. Aneurysms may also be due to an inherited disease such as the Marfan syndrome.

How is an aneurysm detected?

Aneurysms can be detected by X-ray or by imaging techniques such as echocardiography, an MRI (magnetic resonance imaging) or a computed tomography (CT) scan. A small aneurysm may not cause symptoms. Then a patient's doctor will want to check it regularly to see if it's enlarging. Pain, sometimes severe pain, in the area of an aneurysm is a common symptom. The larger an aneurysm becomes, the more likely it is to burst.

How is an aneurysm treated?

Aneurysms are treated surgically. A patch or artificial piece of blood vessel is sewn where the aneurysm was to reinforce the aorta so that it does not burst again.

Ruptured Aortic Aneurysm

The aorta is such a large blood vessel that if it ruptures death is very rapid although the process might be slow enough to permit emergency surgery. However, time is of the essence. The ideal management is to repair the aneurysm before rupture occurs. Often there is no knowledge of the presence of an aneurysm and the first sign is rupture, rapid exsanguination and death.

Aortic Dissection

A related but different condition is aortic dissection. Dissection refers to a separation of the vessel wall, which allows blood to leak between the layers of the vessel. This further damages and weakens the vessel, placing it at much greater risk of bursting (rupture).

Because the abdominal aorta is such a large vessel, a ruptured abdominal aneurysm is a life-threatening event.

• Fortunately, not all aneurysms rupture right away. Many grow very slowly and cause no symptoms or problems for many years.
• When detected in time, most aneurysms can be electively repaired with an operation so they do not rupture.

Each year, about 15,000 people in the United States die of a ruptured abdominal aneurysm. This makes it the 13th leading cause of death in this country.

• Most aneurysms occur in people aged 55 years or older.
• The number of aneurysms in the United States is increasing as the population increases and ages.
• Aneurysms are 4 times more common in men than in women.

Aortic Aneurysm Malpractice

There are four life threatening conditions that can cause chest pain (1) a heart attack; (2) pulmonary embolism (3) aortic rupture/dissection (4) pneumothorax.  When a patient is seen by a nurse or doctor in the office, at the Urgent Care or in the Emergency room with chest pain, it is the doctor’s first responsibility to rule out or eliminate these life threatening conditions.  This is done by taking a thorough history, performing a complete physical examination and by promptly completing appropriate diagnostic tests.

Failure of health care personnel to consider and rule out these life threatening causes of chest pain is medical malpractice.

These life threatening conditions are ruled out or diagnosed by the responsible health care professionals by making the appropriate differential diagnosis, by taking an adequate history, performing a thorough physical examination, ordering  and properly interperting   appropriate tests.

History

A dissecting or ruptured aneurysm usually presents with pain. In a TAA it will cause chest pain that may be indistinguishable from acute myocardial infarction in terms of nature and distribution. Coughing up blood can occur.

Ruptured AAA presents with a classical triad of pain in the flank or back, hypotension and a pulsatile abdominal mass but only about half have the full triad. The patient will complain of the pain and may feel cold, sweaty and faint on standing. The following symptoms are listed with approximate frequency of presentation:

Physical Examination

A patient with a ruptured aneurysm at any level is likely to look pale and unwell and to be cold and sweaty. The pulse will be rapid, weak and thready. Hypotension is common.

With a ruptured AAA there may well be a pulsatile mass in the vicinity of the bifurcation of the aorta. This is a few centimeters above the umbilicus and a little to the left. It may be tender and a bruit may be audible. Bleeding causes peritoneal irritation and it may appear as an acute abdomen. The following findings are listed with approximate frequency:

• Palpable mass 90%
• Tenderness 80%
• Systolic blood pressure below 80mm Hg 40%

Presentation can be atypical such as intestinal obstruction from haematoma or an apparent irreducible inguinal hernia
A full exam, with special attention to the cardiovascular system and abdomen, will give clues to the diagnosis.

• The health care provider may be able to feel a pulsating bulge in your belly or hear a loud pulse or other signs of aortic enlargement with the stethoscope.
• The exam findings will guide the rest of the evaluation.

Diagnostic Tests
Probably the first test that will be performed is an electrocardiogram (ECG or EKG). This is done to rule out a heart attack and other serious heart conditions.
An ultrasound, x-ray, computed tomography (CT) scan, angiogram, or magnetic resonance imaging (MRI) of the chest and abdomen may be done.

• Usually, an aneurysm shows up on plain radiographs only if it has become calcified as a result of atherosclerosis.
• Ultrasound will show abnormalities in the shape of your aorta. Echocardiography is a special type of ultrasound that shows the heart in great detail. This may be done in certain situations in which heart damage is suspected and/or the thoracic aorta is thought to be involved. A transesophageal echocardiogram is more sensitive and specific; the procedure involves swallowing a long tube with a probe at its distal end. Prior to placement of the probe, local anesthesia is applied to the back of the throat. This probe is very sensitive and can easily identify heart or aortic problems within a few minutes.
• Aortography is an x-ray procedure done after a contrast or x-ray dye is injected into the blood stream. This study highlights abnormalities, such as bulges, and confirms the diagnosis of aneurysm. Aortography involves inserting a catheter inside the body and aorta, with its associated risks.
• A CT scan is a fancy x-ray that shows much more detail of the organs, blood vessels, and other structures inside the body. It requires the use of a dye, which can damage the kidney in rare cases.
• MRI is also a fancy, highly specialized technique that gives a very detailed view of the inside of the body.
• CT scan and MRI have largely replaced aortography. The only hazard of CT scan and MRI is that the patient is left unattended in a radiological suite for about 20-30 minutes, which may not be advisable for a patient with low blood pressure.

Differential Diagnosis

• Whenever a man over 55 or a woman over 70 presents with circulatory collapse a ruptured aneurysm should be considered.
• The differential diagnosis for a ruptured TAA is that of chest pain, especially myocardial infarction with cardiogenic shock but also massive pulmonary embolism.
• The differential diagnosis for ruptured AAA involves other causes of abdominal pain including acute abdomen. A high white cell count occurs in 80% and should not detract from the possibility of a ruptured aneurysm. An infected, toxic patient will be peripherally warm with a bounding pulse but here there is circulatory collapse and a cold periphery. Renal colic, gastrointestinal haemorrhage and diverticular disease all need consideration.

If you have lost a loved one because an ruptured or dissecting aortic or thoracic aneurysm was not properly diagnosed or treated contact Medical Malpractice lawyer Steven Weinberg for a free case evaluation.