Type A aortic dissection

Case contributed by Dr Derek Smith

Presentation

Out of hospital cardiac arrest with immediate CPR (by off-duty medics) and ROSC after 5 cycles. Short history of preceding sharp central chest pain.

Patient Data

Age: 80
Gender: Female
Modality: X-ray

Clear pulmonary fields. No skeletal abnormalities.  Normal cardiac silhouette.  Inward displacement of atherosclerotic calcification at aortic arch.

The patient was admitted for observation until blood results were available.  Troponin was normal but the d-dimer was elevated at 7000 (normal <230).  The medical team arranged a CTPA which was performed the morning after admission.

Modality: CT

CTPA then CT aortogram (arch to bifurcation):

  • no evidence of pulmonary emboli.
  • Stanford type A aortic dissection terminating at origin of left subclavian artery.  No extension into, nor occlusion of descending thoracic aorta or major vessels.

Case Discussion

This patient was referred to the cardiothoracic service in the same hospital and underwent immediate surgical repair with a prolonged stay in intensive care.

With review, there were signs on the admission chest film suggestive of aortic dissection (displaced calcified ring at apex of arch) in keeping with the history of chest pain but the diagnosis was confirmed on CTA.

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Case Information

rID: 33029
Case created: 28th Dec 2014
Last edited: 17th Jan 2017
Systems: Vascular, Chest
Inclusion in quiz mode: Included

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