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 years
Gender: Female
X-ray

On admission

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.

CT

Good enhancement of pulmonary vasculature.  Intimal flap with calcification noted in aorta and scan re-protocolled and repeated.

Good opacification of thoracic and abdominal aorta. Dissection flap arising ~4 cm from sinus of Valsalva and extending to origin of left subclavian.  No extension in great vessels or coronary circulation.  Maximal arch diameter of 4.4 cm.

Trace of pericardial fluid and small bilateral pleural effusions.

No major abdominal or pelvic abnormalities (from full scan).

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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.