Presentation
Chest discomfort, uncontrolled hypertension, hypercholesterolemia and widened mediastinum on CXR. Echo by ER doctor showed a pericardial effusion.
Patient Data
Aortic arch contour deformity with a triangular contrast dense opacity suggestive of an ulcerated plaque and impending dissection. Dense pericardial effusion, consistent with hemopericardium. No intimal flap.
3D volume-rendered image nicely demonstrates the "acquired diverticulum like" protrusion
Case Discussion
CT aortogram (abdominal aorta not shown) shows a contour deformity at the ascending aorta/arch junction that opacifies with contrast mostly likely representing a non-calcified ulcerated atherosclerotic plaque. Dense pericardial effusion extending beyond the anatomic boundaries (into around the arch) in keeping with acute leaking. No dissection intimal flap seen in this study.
Later a second assessment with echocardiography by the cardiologist revealed a dissection flap - Stanford A (half-hour after the CT) and clotted blood in the pericardium.
This is within the spectrum of an acute aortic syndrome.
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