CTICasesAcute Type A Dissection with Hemopericardium and Right AV Groove Hematoma
Imaging findings
CT demonstrates an acute type A aortic dissection with a large fenestration in the ascending aorta and hemopericardium. Importantly, there is blood tracking along the right atrioventricular groove, producing a hematoma that follows the entire course of the right coronary artery in the AV groove within the epicardial fat deep to the pericardium. This blood collection in the AV groove is well-defined and narrow, following the course of the RCA, and initially created concern for narrowing of the right ventricular outflow tract on echocardiography.
Key takeaways
In acute aortic dissection with hemopericardium, blood may dissect along the epicardial fat in the right atrioventricular groove, producing a hematoma that follows the entire course of the right coronary artery. This AV groove hematoma pattern has been observed to preferentially track along the right coronary artery territory specifically. The CT appearance of high-attenuation material following the AV groove should not be mistaken for other pathology such as angiosarcoma or pericardial tumor. In the context of TAVI, rupture of the aortic root can produce a similar hematoma pattern surrounding the RCA in the AV groove.
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