Penetrating aortic atherosclerotic ulcer
Chest discomfort, uncontrolled hypertension, hypercholesterolaemia and widened mediastinum on CXR. Echo by ER doctor showed a pericardial effusion.
Loading Stack -
0 images remaining
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.
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 on 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 acute aortic syndrome.