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

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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