CTICasesAscending Aortic Intimal Tear with Mediastinal Hemorrhage
Imaging findings
Serial non-gated and gated CT angiography scans of a patient with acute chest pain show soft tissue thickening and hemorrhage within the mediastinum surrounding the ascending aorta and tracking along the pulmonary artery sheaths. Gated CT angiography clearly defines a focal, subtle intimal tear in the ascending aorta without evidence of a classic dissecting membrane or flap.
Key takeaways
A focal intimal tear of the ascending aorta can present with mediastinal hemorrhage tracking along the pulmonary and aortic sheaths, mimicking aortitis or vasculitis on non-gated studies. Gated CT angiography is critical to differentiate motion artifact from a true, subtle intimal tear, which represents a form of acute aortic syndrome that can rapidly progress to a frank type A dissection.
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