Moderate to large sized dense pericardial effusion measuring up to 20 mm with an attenuation of 55 HU in keeping with hemopericardium.

There is a mural crescenteric dense opacification on the non contrast phase extending from the sinotubular junction, through the ascending arch and into the proximal descending aortic arch is consistent with mural hematoma.

A linear hyperdensity on the CTA attached to left wall of the sinotublar junction, extending 16mm into the aortic lumen is consistent with a dissection flap which only extends a short distance into the proximal ascending aorta. The origin of left and right coronary artery are not involved with this dissection flap.

Dependent changes of the lungs bilaterally. No pleural effusion or pneumothorax. Although not a dedicated study, there is no large central pulmonary embolism. No lymphadenopathy by CT size criteria.

Impression:

• acute aortic syndrome with a small dissection flap originating at the sinotubular junction and extending into the proximal ascending aorta with associated moderate to large volume hemopericardium

• long segment of aortic intramural hematoma extending from the aortic root through to the proximal descending aorta

• there is another faint linear hyperdensity on the anterior abdominal aorta wall between the celiac and SMA origin. This may represent turbulant flow however a second aortic dissection flap is not ruled out and CTA of the abdominal aorta is required