Spontaneous Stanford type B dissection of the thoracic aorta masquerading as pulmonary embolism

Case contributed by Dr Chris O'Donnell


Presented to the ED with central chest pain and elevated D-dimer.

Patient Data

Age: 70 years
Gender: Male

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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Case information

rID: 16309
Published: 9th Jan 2012
Last edited: 28th Sep 2019
System: Vascular, Chest
Inclusion in quiz mode: Included

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