A 38-year-old male patient was seen in the ED for chest pain, his cardiac workup was negative and the patient was discharged. Our radiologist called me the following morning to inform us that the patient had an abnormal chest x-ray which could represent adenopathy or an abnormality of the aorta. I spoke to Ricky, who is in charge of our overread follow-ups. He attempted to call the patient but the patient did not have a phone. Ricky then asked Touro security to drive him to the patient's apartment. The patient resisted a return to the ED because he was no longer having chest pain and felt fine. Ricky insisted and expressed the urgency of a return to the ED. The patient reluctantly returned. We performed a CTA chest and 2D echo which revealed an acute thoracic aortic dissection. The patient was transferred to UMC where he underwent emergency surgery.
I spoke to Dr. R today and the patient is doing great. Dr. R also wanted to thank Ricky because he saved this man's life! This condition often goes undetected until the dissection is beyond repair and causes death. This is the same condition that killed the actor John Ritter. Thoracic aortic dissection has a 40% mortality rate. Dr. R is convinced that without Ricky's intervention and insistence that this patient return to the ED, he may have perished.