Presentation
Acute onset of chest pain. Having had hypertension, he underwent aortic valve replacement surgery due to bicuspid aortic valve the year before. CT scan is performed for the assessment of aorta, and exclusion of acute aortic syndromes.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Contrast-enhanced CT scan shows aneurysmal dilatation of the ascending aorta which contains an intimal flap. There is also evidence of previous sternotomy, aortic valve prosthesis, and right-sided pleural effusion. Reflux of contrast agent into the coronary sinuses, pulmonary veins, and phrenic veins is evident.
In addition, you can see the layering of the contrast material within the SVC where the formation of the blood-contrast level occurs under the influence of a large compressing aneurysm. Accumulations of the contrast material in the right chest wall veins and dependent dorsal veins of the back are also evident.
Case Discussion
Dissecting aneurysm of the ascending aorta (Stanford A and De Baky 1& 2 subtypes) with pressure effect of the aneurysm leads to hemodynamic alteration in the cardiac chambers resulting in reflux of the contrast material into the coronary sinuses, and pulmonary veins.