Presentation
Chest pain.
Patient Data
Ascending thoracic aortic dissection which extends from the aortic root to at least the mid thoracic aorta. Stranding about the ascending aorta and aortic arch, raising concern for early rupture. Right coronary artery may arise from the false lumen. Left coronary artery arises from the true lumen with heavy calcifications. Bolus timing is early for the evaluation pulmonary embolus. No large or central pulmonary embolus is identified.
Case Discussion
This could be a terrifying case for first and second year radiology residents, or even practicing radiologists to take on-call, particularly when tired. This life-threatening finding of aortic dissection with possible early rupture is barely noticeable when focussing on the evaluation for acute pulmonary embolus. This case provides a great reminder to perform as detailed as possible of an evaluation of the entire chest, even when performing a directed study such a CTA for PE.
The patient underwent successful graft repair of the ascending aorta.
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