Presentation
Left chest pain and tenderness. ?Pulmonary embolism
Patient Data
There is abnormal crescentic high density and thickening of the wall of the thoracic aorta, extending from the posterior aortic arch through the descending aorta. Findings are in keeping with an acute intramural hematoma. The hematoma appears to arise distal to the left subclavian artery. There is a small focus of high-density contrast within the aorta wall (within the hematoma) at the posteromedial aortic arch consistent with a penetrating atherosclerotic ulcer.
No acute pulmonary embolism.
Small left pleural effusion. Motion artifact through the lower hemithorax. Background emphysema and basal atelectasis.
Case Discussion
Patients who present with undifferentiated severe acute chest pain often undergo CTPA to exclude acute pulmonary embolism as the underlying cause. Occasionally, patients will be subsequently diagnosed with acute aortic syndrome as in this case. The thoracic aorta is an important review area on CTPA as even a non-dedicated study may reveal underlying acute intramural hematoma, aortic dissection or aneurysm.