Presentation
Breathless. Collapse. Pericardial effusion on USS. Aortic dissection?
Patient Data
AP
Despite the AP projection the mediastinum is widened.
Lungs clear. No pleural effusion.
Dissection flap extending from just above a dilated aortic root and extending the whole length of the thoracic aorta.
Moderate sized hemopericardium.
Hiatus hernia. Minor basal atelectasis.
Case Discussion
This is a Type A aortic dissection with a large hemopericardium. The density of this is well illustrated as blood on the unenhanced images.
I like the plain radiograph in this case. Our automaton response (for those who still report plain radiographs) is its an AP projection, I wont comment on the heart or mediastinum due to magnification.
But this looks suspicious and the clinician has given a good history to lead one that way with concerns over a dissection.
Couple of thoughts on this:
1. Good clinical information is important, despite it being less fashionable to provide in recent years
2. Clinician information makes a difference for;
a. the patient (quicker, better outcome)
b. the radiologist, as they feel more engaged and valued in the diagnostic process
3. Hot reporting of plain radiographs can be fun.
Try it on call sometime between all the CT's or for an hour in your normal job plan.
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