Presentation
Chest pain
Patient Data
We see the coronal, sagittal reconstructions, and the axial series performed with pulmonary embolism protocol.
The truncus pulmonalis and the pulmonary arteries are without filling defects.
A hypodense thin line surrounds the aortic wall.
We see the coronal, sagittal reconstructions, and the axial series performed with pulmonary embolism protocol.
The pulmonary vessels still do not have any filling defects.
An intimal flap is seen in the aortic arch extending to the proximal part of the descending aorta.
Case Discussion
The patient came to the emergency unit with chest pain. She was sent to the CT with a suspected pulmonary thromboembolic diagnosis. On the first CT, we can not see embolus in the pulmonary arterial vessels. A thin hypodense line surrounded the aortic wall, and aortitis was suggested as the diagnosis.
Two weeks later, the patient returned to the emergency unit and was sent back to the CT, where we found aortic dissection involving the arch and a part of the descending aorta.
Aortic dissection occurs when the innermost part of the wall allows the blood to flow between the layers.
In general symptoms hav a sudden onset with severe chest or back pain.
Predisposing conditions can be smoking, high arterial pressure, cocaine use, and many diseases like Ehlers-Danlos or Marfan syndrome, or inflammation of the arteries. (like Takayasu disease).
The appearance of the aortic wall, surrounded by the hypodense line in our patient on the first CT, could suggest inflammation of the aortic wall, but in context of the later imaging findings it most likely represented aortic intramural hematoma.
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