Abstract：
OBJECTIVE: Non-A non-B (NANB) aortic dissections are uncommon and frequently unrecognized diseases. However, their proper identification is crucial given the unpredictable behaviour of the dissected aorta with potential mortality and increased morbidity. We investigate the accuracy of radiological computed angio-tomography (CTA) reports in the diagnosis of acute NANB and the risk related to delayed recognition or misdiagnosis.
METHODS: The pre-treatment contrast CTA of all consecutive patients admitted with acute aortic dissection (AAD) in a University Hospital in London (UK) between January 2017 and May 2023 were reviewed to retrospectively verify the accuracy of CTA reports in the diagnosis of NANB AAD (B1-2D The risk related to the delayed diagnosis (morbidity, mortality, and hospital re-admissions) were evaluated as secondary outcomes. The study was conducted according to the STROBE guidelines.
RESULTS: Overall, 588 aortic CTAs were reviewed for a total of n=393 (66.8%) type A AADs, n=171 (29%) type B AADs and n=25(4.3%) NANB AADs (n=16, 64% men, mean age 60.56, DS+/- 14.6 years). While no case of misdiagnosis was identified in Type A or B AAD groups, in NANBs only about a third of cases (n=9, 36%) were immediately indicated as \"NANB\" (n=2, 8%) or \"B with retrograde extension into the arch\" (n=7, 28%), n=8 cases (32%) were described generically as \"arch dissections\" (n=6, 24%) or \"type A and B\" AAD (n=2, 8%). The remaining 32% of patients received a diagnosis that did not include mention of the arch, as n=6(24%) cases were reported to be \"type A\" and n=2(8%) to be \"type B\" AADs. Despite the heterogeneity of terms used to describe NANB AAD, no case of cardiac tamponade, new onset malperfusion nor neurological complications were reported, and no sudden death nor home-discharge and readmission while waiting for the proper diagnosis.
CONCLUSIONS: The heterogeneity of terms used to describe NANB aortic dissection highlights the need for increased awareness, adoption of in guideline based classification systems, and further education to better understand and correctly address this challenging entity, minimizing misdiagnosis in ambiguous or difficult cases.
METHODS: The pre-treatment contrast CTA of all consecutive patients admitted with acute aortic dissection (AAD) in a University Hospital in London (UK) between January 2017 and May 2023 were reviewed to retrospectively verify the accuracy of CTA reports in the diagnosis of NANB AAD (B1-2D The risk related to the delayed diagnosis (morbidity, mortality, and hospital re-admissions) were evaluated as secondary outcomes. The study was conducted according to the STROBE guidelines.
RESULTS: Overall, 588 aortic CTAs were reviewed for a total of n=393 (66.8%) type A AADs, n=171 (29%) type B AADs and n=25(4.3%) NANB AADs (n=16, 64% men, mean age 60.56, DS+/- 14.6 years). While no case of misdiagnosis was identified in Type A or B AAD groups, in NANBs only about a third of cases (n=9, 36%) were immediately indicated as \"NANB\" (n=2, 8%) or \"B with retrograde extension into the arch\" (n=7, 28%), n=8 cases (32%) were described generically as \"arch dissections\" (n=6, 24%) or \"type A and B\" AAD (n=2, 8%). The remaining 32% of patients received a diagnosis that did not include mention of the arch, as n=6(24%) cases were reported to be \"type A\" and n=2(8%) to be \"type B\" AADs. Despite the heterogeneity of terms used to describe NANB AAD, no case of cardiac tamponade, new onset malperfusion nor neurological complications were reported, and no sudden death nor home-discharge and readmission while waiting for the proper diagnosis.
CONCLUSIONS: The heterogeneity of terms used to describe NANB aortic dissection highlights the need for increased awareness, adoption of in guideline based classification systems, and further education to better understand and correctly address this challenging entity, minimizing misdiagnosis in ambiguous or difficult cases.
摘要：
目的：非A非B（NANB）主动脉夹层是一种罕见且经常无法识别的疾病。然而,考虑到解剖主动脉的不可预测的行为，它们的正确识别至关重要，可能导致死亡率和发病率增加。我们研究了放射学计算机血管断层扫描（CTA）报告在急性NANB诊断中的准确性以及与延迟识别或误诊相关的风险。
方法：对2017年1月至2023年5月在伦敦（UK）大学医院收治的所有连续急性主动脉夹层（AAD）患者的治疗前对比CTA进行回顾性审查，以回顾性验证CTA报告诊断NANBAAD的准确性（B1-2D与延迟诊断相关的风险（发病率，死亡率,和重新入院）被评估为次要结局。该研究是根据STROBE指南进行的。
结果：总体而言，对588例主动脉CTA进行了检查，共检查n=393例（66.8％）A型AAD，n=171（29％）B型AAD和n=25（4.3％）NANBAAD（n=16，64％男性，平均年龄60.56，DS+/-14.6岁）。虽然在A型或B型AAD组中没有发现误诊的病例，在NANB中，只有大约三分之一的病例(n=9，36%)立即显示为“NANB”(n=2，8%)或“逆行延伸到足弓的B”(n=7，28%)，n=8例（32％）通常被描述为“牙弓夹层”（n=6，24％）或“A型和B型”AAD（n=2，8％）。其余32％的患者接受了未提及足弓的诊断，报告n=6例(24%)为“A型”，n=2例(8%)为“B型”AAD。尽管用于描述NANBAAD的术语存在异质性，没有心脏填塞的病例,新发灌注不良或神经系统并发症的报告，在等待正确诊断时，没有突然死亡，也没有家庭出院和再次入院。
结论：用于描述NANB主动脉夹层的术语的异质性突出表明需要提高意识，采用基于指南的分类系统，和进一步的教育，以更好地理解和正确地解决这个具有挑战性的实体，在模棱两可或疑难病例中尽量减少误诊。
方法：对2017年1月至2023年5月在伦敦（UK）大学医院收治的所有连续急性主动脉夹层（AAD）患者的治疗前对比CTA进行回顾性审查，以回顾性验证CTA报告诊断NANBAAD的准确性（B1-2D与延迟诊断相关的风险（发病率，死亡率,和重新入院）被评估为次要结局。该研究是根据STROBE指南进行的。
结果：总体而言，对588例主动脉CTA进行了检查，共检查n=393例（66.8％）A型AAD，n=171（29％）B型AAD和n=25（4.3％）NANBAAD（n=16，64％男性，平均年龄60.56，DS+/-14.6岁）。虽然在A型或B型AAD组中没有发现误诊的病例，在NANB中，只有大约三分之一的病例(n=9，36%)立即显示为“NANB”(n=2，8%)或“逆行延伸到足弓的B”(n=7，28%)，n=8例（32％）通常被描述为“牙弓夹层”（n=6，24％）或“A型和B型”AAD（n=2，8％）。其余32％的患者接受了未提及足弓的诊断，报告n=6例(24%)为“A型”，n=2例(8%)为“B型”AAD。尽管用于描述NANBAAD的术语存在异质性，没有心脏填塞的病例,新发灌注不良或神经系统并发症的报告，在等待正确诊断时，没有突然死亡，也没有家庭出院和再次入院。
结论：用于描述NANB主动脉夹层的术语的异质性突出表明需要提高意识，采用基于指南的分类系统，和进一步的教育，以更好地理解和正确地解决这个具有挑战性的实体，在模棱两可或疑难病例中尽量减少误诊。
