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HERDIN Record #: NCR-PHC-18061911052246 Submitted: 19 June 2018 Modified: 19 June 2018

Diagnostic accuracy of mediastinal width measurements on chest x-ray in the recognition of acute thoracic aortic dissection.

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Background: Accurate assessment of aortic dissection can be made with CT but its utility in the emergency setting in patients with acute thoracic complaints limits its use due to practical reasons. The study aims to examine the accuracy and diagnostic value chest x-ray in identifying thoracic aortic dissection.


Methods: The study included 70 patients with clinical suspicion of having aortic dissection. Radiographic measurements including mediastinal width and left mediastinal width were employed to assess widening of the superior mediastinum. Cut-off value of 8.65 for MW and 5.45 LMW were set. CT aortogram was the gold standard used to identify the presence of dissection.


Results: For MW with measurements, using 8.65 as cutoff value, the following diagnostic test values were obtained: sensitivity of 18%, specificity of 76%, PPV of 40%, NPV of 51%, PLR of 0.77, and NLR of 1.07. LMW, using 5.45 as cutoff value, the following diagnostic test values were obtained: sensitivity of 51%, specificity of 43%, PPV of 45%, NPV of 50%, PLR of 0.91, and NLR of 1.17.


Conclusion: Mediastinal width measurements obtained from AP chest radiographs have low diagnostic power in predicting the presence of aortic dissection. In such cases where there is high suspicion for this pathology, CT aortogram remains the most reliable modality.

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