Lessons from a delayed diagnosis claim: why a history of aortic aneurysm should never be overlooked

An aortic aneurysm is a potentially life-threatening condition that requires ongoing monitoring and careful clinical assessment when patients become unwell. For those with a known history of aneurysm disease or previous aneurysm repair, seemingly common symptoms may sometimes signal a serious underlying problem requiring urgent investigation.

Medical negligence solicitors regularly investigate cases involving delayed diagnosis and missed opportunities for treatment. While every patient’s circumstances are different, one recurring theme is the importance of considering a patient’s medical history and ensuring that potentially life-threatening conditions are properly excluded before a patient is discharged.

What is an aortic aneurysm?

The aorta is the body’s largest artery, carrying oxygen-rich blood from the heart to the rest of the body. An aortic aneurysm occurs when part of the artery wall weakens and bulges outwards. Although some aneurysms remain stable for many years, others can enlarge over time and become at risk of rupture or dissection. An aortic dissection occurs when a tear develops in the inner layer of the aortic wall, allowing blood to travel between the layers of the artery. Both conditions constitute medical emergencies and can rapidly become fatal without prompt diagnosis and treatment. Even where a patient has previously undergone successful aneurysm repair, they may remain at increased risk of future aortic complications and often require long-term surveillance.

Why a patient’s medical history matters

Clinicians are frequently required to distinguish between common, relatively harmless conditions, and rare but life-threatening diagnoses. A patient’s medical history often provides crucial clues in that process. Particular care may be required where a patient has a history of:

• aortic aneurysm or previous aneurysm repair;
• vascular disease;
• high blood pressure;
• smoking;
• heart disease or stroke;
• connective tissue disorders affecting the blood vessels.

When such patients present with unexplained symptoms including chest pain, upper back pain, shoulder pain, neck pain or sudden severe discomfort, clinicians should remain alert to the possibility of a serious cardiovascular cause and investigate appropriately where indicated. While most patients with these symptoms will not have an aortic emergency, the consequences of overlooking one can be devastating.

The importance of prompt investigation

The symptoms of aortic disease are not always straightforward. Although some patients experience severe chest pain, others may present with symptoms affecting the back, shoulders, neck, or upper body. In some cases, they may simply appear generally unwell. Where there is concern about a potential problem affecting the aorta, advanced imaging is often required. A CT aortogram is a specialised scan that allows doctors to assess the aorta and identify conditions such as aneurysms, dissections, leaks, or impending rupture. Prompt imaging can be critical. Identifying an aortic problem before catastrophic deterioration occurs may allow a patient to receive specialist treatment and significantly improve their prospects of survival.

Lessons from a delayed diagnosis claim

One claim the Penningtons Manches Cooper medical negligence team investigated involved an older patient with a history of previous aortic aneurysm surgery who attended hospital complaining of pain affecting the upper body and back. The symptoms were initially attributed to a less serious cause and the patient was discharged. Within hours, however, the patient’s condition deteriorated significantly. Subsequent investigations revealed a serious aortic emergency which ultimately proved fatal.

Independent medical experts instructed during the claim raised concerns about whether sufficient weight had been given to the patient’s history of aortic disease and other vascular risk factors. In their opinion, serious conditions affecting the aorta should have been among the diagnoses actively considered during the initial assessment.

The experts considered that further imaging of the aorta may have been warranted and that earlier identification of the underlying condition could potentially have created an opportunity for specialist intervention before the patient’s condition became irreversible.

The significance of the claim lies not in its individual facts, but in the wider learning it provides. Patients with a history of aortic aneurysm disease may not always present with classic symptoms. When they attend hospital with unexplained pain affecting the chest, back, neck or shoulders, careful consideration should be given to whether urgent investigations are required to exclude a potentially serious aortic complication.

When might there be grounds for a medical negligence claim?

It is important to recognise that not every missed diagnosis amounts to negligence. Medicine is complex and healthcare professionals are often required to make difficult decisions based on the information available at the time. However, concerns may arise where there is evidence that:

• relevant medical history was overlooked;
• serious diagnoses were not properly considered;
• appropriate investigations were not carried out;
• a patient was discharged without reasonable steps being taken to exclude potentially life-threatening conditions;
• delays in diagnosis resulted in avoidable injury or loss of opportunity for treatment.

In these cases, independent expert evidence is usually required to determine whether the care provided fell below an acceptable standard and whether earlier diagnosis would likely have altered the outcome.

Seeking answers after a delayed diagnosis

For families who have lost a loved one following concerns about the diagnosis or treatment of an aortic condition, obtaining answers can be an important part of the grieving process. A detailed review of the medical records, imaging, clinical decision-making, and independent expert evidence can often help establish whether opportunities for earlier diagnosis or treatment were missed.

Alison Johnson, partner in the medical negligence team at Penningtons Manches Cooper, comments: “A history of aortic aneurysm should never be viewed in isolation when a patient presents with new and unexplained pain. One of the recurring themes we see in delayed diagnosis claims is the failure to fully appreciate the significance of a patient’s vascular history. Early recognition, appropriate imaging and prompt referral can make the difference between a treatable condition and a tragic outcome.”