Aortic dissection and aortic aneurysms are among the most critical medical emergencies a patient can face. The aorta is the main artery carrying blood from the heart to the rest of the body. When something goes wrong with this vessel, time is the most valuable commodity.
Unfortunately, because the symptoms can mimic other less severe conditions, delays in diagnosis are not uncommon. In Ireland, a failure to diagnose these conditions promptly can have devastating, life-altering, or even fatal consequences.
If you or a loved one suffered because an aortic dissection or aneurysm was missed, you are likely looking for answers. Below, we explain how these errors occur, the specific landscape of Irish medical care regarding these conditions, and your legal rights if the standard of care was not met.
Aortic Diagnoses
To understand how a claim arises, it is helpful to understand the medical conditions themselves. While they both affect the aorta, they are distinct issues:
- Aortic Aneurysm: This is a bulging or "ballooning" in the wall of the blood vessel. It can grow slowly over time (often silently) but poses a catastrophic risk if it bursts (ruptures).
- Aortic Dissection: This is a tear in the inner layer of the aorta. Blood rushes through the tear, causing the layers of the artery wall to separate (dissect). This is an immediate, surgical emergency.
Signs and Symptoms
Recognising the warning signs is the first step in proper medical treatment. In legal terms, we look at whether a competent doctor should have recognised these signs based on the patient's presentation.
Aortic Dissection: Symptoms that Mimic Other Emergencies
Aortic dissection is notorious for being a "great masquerader." It often looks like a heart attack or a stroke. However, there are specific characteristics that should trigger further investigation:
- Sudden, severe pain: Patients often describe a "tearing" or "ripping" sensation.
- Migrating pain: The pain often starts in the chest and moves to the back (between the shoulder blades) or down the abdomen.
- Pulse deficit: A difference in pulse strength or blood pressure between the left and right arms.
- Neurological signs: Fainting, confusion, or stroke-like weakness.
Abdominal Aortic Aneurysm (AAA): Silent Risks and Rupture Signs
An Abdominal Aortic Aneurysm (AAA) often develops without any obvious symptoms. However, as it grows or begins to leak, warning signs appear:
- Pulsating sensation: A feeling of a "heartbeat" in the abdomen.
- Deep, constant pain: Usually in the abdomen or on the side (flank).
- Sudden, severe back pain: This is the classic sign of a rupture or impending rupture.
Common Misdiagnoses: What Conditions Are They Mistaken For?
Because the aorta runs from the chest down through the abdomen, pain can manifest in various locations. Consequently, these conditions are frequently misdiagnosed as:
- Myocardial Infarction (Heart Attack): Because of chest pain.
- Gastritis or Acid Reflux: Due to upper abdominal or chest discomfort.
- Renal Colic (Kidney Stones): Due to sudden, severe flank or back pain.
- Musculoskeletal Back Pain: Particularly if the patient has a history of back issues.
A misdiagnosis alone is not always negligence. Negligence occurs when a doctor fails to rule out the life-threatening aortic condition before settling on a minor diagnosis, specifically when the symptoms warranted a scan.
Where the Errors Happen
Aortic Dissection
Aortic dissection claims generally focus on the timeline: When did the patient present, and how long was the delay?
Missed Opportunities in Primary Care and A&E
The "patient journey" usually begins with a GP visit or an ambulance to A&E. Errors here are critical because survival rates drop by the hour.
- GP Referral Failures: A GP may attribute chest or back pain to a muscle strain without checking blood pressure in both arms or considering the patient's risk factors (such as Marfan syndrome or high blood pressure).
- Triage Errors: In A&E, a patient with chest pain is usually triaged as high priority. However, if the ECG is normal (which it often is in dissection cases), the patient might be deprioritised or left waiting, mistaken for a gastric patient.
- Discharge Without Investigation: The most dangerous error is sending a patient home with painkillers for "back pain" without performing a CT scan or keeping them for observation.
Radiology and Imaging Delays
Radiology is the gold standard for diagnosis. A CT Aortogram is usually required to confirm a dissection. Negligence can occur in three ways here:
- Failure to Order the Scan: The doctor suspects a heart attack, gets a normal Troponin (heart enzyme) result, and stops investigating.
- Delays in Scanning: A scan is ordered, but the patient waits hours on a trolley due to departmental overcrowding.
- Misreading the Images: A radiologist might miss a subtle dissection flap on a scan, or the scan might be performed without contrast dye, making the dissection invisible.
Aortic Aneurysm
Aneurysm cases often differ from dissection cases because there is frequently a long history of "missed chances" before the catastrophic rupture occurs.
Missed Incidental Findings
Many aneurysms are found "incidentally",meaning they appear on a scan done for another reason (like a kidney or spine scan).
- Failure to Report: A radiologist notes the aneurysm but fails to flag it clearly in the report conclusion.
- Failure to Act: The report mentions the aneurysm, but the referring doctor (GP or Consultant) does not inform the patient or set up a monitoring plan.
- Monitoring Failures: A patient with a known small aneurysm requires regular ultrasound surveillance to check for growth. If this system fails and the patient is lost to follow-up, the aneurysm may grow to a dangerous size unnoticed.
Failure to Diagnose Rupture or Leak
When a patient with a known aneurysm (or an undiagnosed one) arrives at A&E with sudden back pain and low blood pressure, it is a medical emergency.
A classic error involves a patient presenting with back pain and collapsing. If the medical team assumes it is simple fainting or back spasms, they lose the narrow window of opportunity for emergency vascular surgery. Failure to recognise the triad of back pain, hypotension (low blood pressure), and a pulsatile mass is a significant breach of duty.
The Reality of Aneurysm Screening in Ireland
The context of your care is vital. Unlike the UK, which has a widespread NHS Abdominal Aortic Aneurysm Screening Programme for men over 65, Ireland does not currently have a national population-based screening programme for AAAs.
This systemic gap places a heavier burden on opportunistic detection. In Ireland, most aneurysms are detected largely by chance or when symptoms eventually develop.
This reality impacts legal cases. It means that GPs and hospital doctors must be hyper-vigilant when patients present with risk factors (such as being male, over 65, a smoker, or having a family history).
Because there is no automatic screening safety net, the failure of a doctor to investigate vague abdominal or back symptoms in a high-risk patient becomes even more critical. If a doctor dismisses these symptoms without considering an aneurysm, it may be difficult to defend that decision legally.
Establishing Medical Negligence in Aortic Cases
Medical negligence law in Ireland is complex. It is not enough to show that a mistake happened; we must prove that the care fell below an acceptable standard and that this failure caused the injury.
Proving Breach of Duty and Causation
To succeed in a claim, two main pillars must be established:
- Breach of Duty: We must prove that no competent doctor of the same status and skill would have acted in the same way. For example, would a competent A&E consultant have sent a patient with tearing chest pain home without a scan? If the answer is no, there is a breach of duty.
- Causation: This is often the most contested area in aortic cases. We must prove that, had the diagnosis been made earlier, the outcome would have been different. For example, if the dissection was diagnosed three hours earlier, would the patient have survived the surgery?
The Critical Role of Expert Evidence
Judges in Ireland rely heavily on independent expert witnesses. We cannot simply argue that an error occurred; we must present evidence from senior medical professionals.
In aortic cases, we typically engage:
- Emergency Medicine Consultants to comment on the initial triage and assessment.
- Vascular Surgeons to advise on whether surgery would have been successful had the diagnosis been timely.
- Radiologists to review whether scans were interpreted correctly.
We work with a panel of highly respected international experts to ensure your case is supported by robust, objective opinion.
Evidence and The Legal Process
Starting a legal investigation can feel overwhelming. We aim to make the process as transparent and stress-free as possible.
Gathering Key Evidence: Records and Radiology
The foundation of any case is the medical file. Our team will take up the burden of requesting:
- GP Notes: To check for previous complaints or risk factors.
- Hospital Records: Including triage notes, nursing notes, and blood results.
- Radiology Imaging: We request the actual discs of CT scans or X-rays, not just the written reports, so our independent experts can re-examine them.
Who Is the Claim Against? (Public vs. Private Care)
- Public Patients (HSE): If the negligence occurred in a public hospital, the defendant is usually the Health Service Executive (HSE). These claims are managed by the State Claims Agency (SCA) under the Clinical Indemnity Scheme. We deal directly with the SCA on your behalf.
- Private Patients: If the care was provided by a private consultant or GP, the claim is usually against the individual doctor, who will be indemnified by a defence organisation (such as the Medical Protection Society).
Time Limits
In Ireland, the general rule is that you have two years to issue legal proceedings.
However, in medical negligence, the clock usually starts ticking from the Date of Knowledge. This is the date you found out (or should have known) that the injury was caused by negligence.
For example, if a misdiagnosis occurred in 2021, but you only discovered in 2023 that the error was avoidable, the two-year period might start from 2023. This is a complex area of law, and immediate legal advice is essential to prevent your case from becoming statute-barred.
Life After Delayed Aortic Diagnosis
Aortic events are physically and psychologically traumatic. When we investigate a case, we look beyond the initial error to the lifelong impact on the patient.
Long-term Health Consequences
Survivors of a delayed diagnosis often face significant challenges:
- Organ Damage: A dissection can cut off blood supply to the kidneys, gut, or spinal cord, leading to organ failure or the need for dialysis.
- Mobility Issues: If the blood supply to the spinal cord is compromised, it can result in paralysis or paraplegia.
- Neurological Impact: A stroke resulting from a dissection can lead to long-term cognitive or speech deficits.
Our role is to quantify these future care needs, ensuring that any settlement covers the cost of rehabilitation, home adaptations, and loss of earnings.
Fatal Claims and Inquests
Tragically, many aortic misdiagnosis cases result in death. In these instances, we act for the estate and the dependents (usually the spouse and children).
We also provide representation at Coroner’s Inquests. An inquest is often the first time a family hears the full details of what happened. While the Coroner cannot attribute blame, the evidence gathered at an inquest is often vital for the subsequent civil claim for negligence. We support families through this difficult process, asking the necessary questions to establish the facts.
Why Choose Michael Boylan LLP?
Medical negligence is a highly specialised area of law. Aortic cases, in particular, require a solicitor who understands vascular medicine as well as the law.
Specialist Experience in Complex Vascular Litigation
At Michael Boylan LLP, we are widely recognised as leaders in medical negligence litigation. Our partners have successfully concluded numerous high-value cases involving delayed diagnoses of vascular emergencies. We understand the nuances of the Irish healthcare system, the protocols of the State Claims Agency, and the specific medical criteria required to prove a breach of duty.
A Client-Focused Approach to Investigation
We know that by the time you contact us, you have already been through a traumatic experience. Our approach is:
- Empathetic: We listen to your story with patience and understanding.
- Transparent: We will give you an honest assessment of your chances of success. If we do not believe there is a case, we will tell you gently and clearly.
- Thorough: We leave no stone unturned in investigating the medical records to find the answers you deserve.
Frequently Asked Questions
How long do I have to take a medical negligence case in Ireland?
Generally, you have two years from the date of the injury or the "Date of Knowledge" (when you first realised the injury was due to medical error). Because establishing the Date of Knowledge can be legally complex, we recommend seeking advice as soon as possible.
Does the Injuries Resolution Board assess medical negligence cases?
No. The Injuries Resolution Board (formerly PIAB) typically declines to assess medical negligence claims because they involve complex issues of liability and causation. These cases usually proceed through the court system, although most are settled via negotiation or mediation without a trial.
What if the missed diagnosis happened in A&E versus through my GP?
The legal principles are the same, but the defendant differs. A&E claims are usually against the hospital (HSE), managed by the State Claims Agency. GP claims are against the individual doctor. We handle both types of claims routinely.
What records should I request and how do I request them?
You are entitled to your medical records under Freedom of Information (public hospitals) or GDPR (private/GP). However, we usually recommend letting us request them for you. We know exactly what to ask for,including audit trails and imaging discs,which ensures nothing is missed.
What is the State Claims Agency’s role in public hospital claims?
The State Claims Agency (SCA) manages claims on behalf of the HSE. They act as the "insurer" for public hospitals. Our firm has extensive experience negotiating with the SCA to achieve fair resolutions for our clients.
Can aortic dissection be mistaken for something else?
Yes, frequently. It is most commonly mistaken for a heart attack (myocardial infarction), severe indigestion, or muscular back pain. However, competent medical staff should be able to distinguish these conditions using physical exams and CT scans.
Are abdominal aortic aneurysms always symptomatic?
No. AAAs are often "silent" until they grow large or rupture. This is why incidental findings (spotting them on scans for other issues) are so important, and why failing to act on those findings can be considered negligence.
Get Expert Legal Advice Today
If you suspect that an aortic dissection or aneurysm was missed due to medical negligence, do not try to traverse the complex legal landscape alone.
Contact Michael Boylan LLP today to arrange an initial consultation. We will listen to your experience, review the facts, and help you determine if you have a valid claim.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
