Spontaneous Stanford type B dissection of the thoracic aorta masquerading as pulmonary embolism
Presentation
Presented to the ED with central chest pain and elevated D-dimer.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
CT pulmonary angiogram (CTPA)
Normal pulmonary arteries but crescent of hypodensity in the aortic wall indicates dissection.
CT angiogram (CTA)
The patient was also scanned in the arterial phase, thanks to alert radiographers who identified the hypodense crescent in the descending aorta. The scan confirmed aortic dissection.
Gross ectasia and tortuosity of celiac axis and branches, presumably atherosclerotic and predisposing to dissection.
Case Discussion
Beware of other chest pain causes on CT pulmonary angiogram (CTPA) - the ED doctors are often not that good at clinically differentiating the possible pathologies. Seems like chest pain and positive D-dimer = immediate CTPA in most centers. 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.
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.
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