Spontaneous Stanford type B dissection of the thoracic aorta masquerading as PE
Presentation to ED with central chest pain and elevated D-dimer
As is routine for such a case, ED doctor ordered CTPA for ? PE
Loading Stack -
0 images remaining
normal pulmonary arteries but crescent of hypodensity in the aortic wall indicates dissection confirmed on CT aortic angiogram
Beware of other chest pain causes on CTPA - the ED doctors are often not that good at clinically differentiating the possible pathologies. Seems like chest pain and +ve D-dimer = immediate CTPA in most centres. Radiographers in this case have done an excellent job in catching the contrast bolus in the pulmonary arterial system. Thoracic aortic contrast is minimal thus findings of dissection are minimal and subtle.
Along with the DeBakey classification, the Stanford classification is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. Immediate surgical repair is normally proposed for type A dissection or complicated type B dissection.