CTICasesMissed Type A Aortic Dissection with Giant Ascending Aortic Aneurysm
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Imaging findings
Pulmonary embolism protocol CT for chest pain demonstrates exceptionally early contrast timing, with almost all contrast confined to the pulmonary arteries and very little reaching the left heart. There is a pericardial effusion. The ascending aorta is significantly dilated, measuring over 5.5-6 cm. No direct evidence of dissection flap or intramural hematoma was reported initially.
Key takeaways
A "too good to be true" PE study (contrast mostly in pulmonary arteries, little to left heart) often indicates severely decreased left ventricular function, which can be a secondary clue to other acute cardiac pathologies. Significant ascending aortic dilation (aneurysm) in a patient with chest pain should always prompt thorough evaluation for dissection, even on PE protocol studies. Even without direct visualization of a dissection flap, secondary signs like a large aneurysm and impaired LV function should raise high suspicion for aortic dissection.
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