CTICasesUlcerated Aortic Plaque Mimicking Dissection
Imaging findings
An immunocompromised, acutely ill patient with right upper lobe pneumonia and chronic renal disease has new high-density material displacing the aortic intimal calcifications, with bending and apparent new density that was absent about a month earlier, raising concern for dissection. Workup showed no dissection; the finding represented ulcerated plaque with mural thrombus. The patient is anemic with blood measuring near-fluid attenuation on both studies, and there is also new dense material in the right pectoral muscle.
Key takeaways
New displaced intimal densities and high attenuation along the aortic wall can mimic dissection but may represent ulcerated plaque with layering fresh mural thrombus. The unexplained rapid appearance of the density, together with new soft-tissue calcification elsewhere in an end-stage or worsening renal failure patient, raised the possibility of a metastatic/dystrophic calcification contribution from a deranged calcium-phosphate product, though the cause remained uncertain.
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