Survivors of type A aortic dissection require lifelong surveillance and present unique diagnostic challenges when new symptoms arise. Cognitive biases, including anchoring bias, may cause medical practitioners to overprioritize vascular etiologies, thereby delaying recognition of more common non-vascular conditions. We report the case of a 59-year-old male with a history of type A aortic dissection diagnosed in 2016 and managed conservatively with medical therapy and long-term imaging surveillance, who later presented with both a hepatic mass lesion and recurrent ureteral stones. The patient’s history of catastrophic vascular disease created a persistent anchoring bias that influenced subsequent diagnostic pathways. A 4.4 cm liver mass raised suspicion for malignancy due to its arterial enhancement pattern. This initial concern for malignancy resulted in prolonged diagnostic uncertainty. Ultimately, the mass lesion proved to be a benign lesion of focal nodular hyperplasia (FNH), diagnosed following biopsy. The acute presentation of right flank pain initially prompted evaluation for aortic complications before the diagnosis of an obstructing ureteral stone, ultimately requiring four extracorporeal shock wave lithotripsy (ESWL) procedures. Diagnostic delays were further compounded by concurrent healthcare system disruptions during a period of workforce instability in South Korea. This case illustrates how prior catastrophic vascular disease can create durable diagnostic anchoring, delaying recognition of common non-vascular conditions. System-level disruptions further amplified this delay. Implementation of structured diagnostic approaches and cognitive forcing strategies may mitigate anchoring bias in high-risk vascular populations.
Park et al. (Wed,) studied this question.