Aortic dissection on Cardiac CTA
This is a amazing gated CTA showing a real time cine clip of a dissecting aortic aneurysm. This was a cardiac CTA done for chest pain, and this huge Sanford Type A aortic dissection was discovered!
A Type A dissection is an intimal tear of the ascending aorta, whereas a Type B involves the descending aorta. A Type B dissection is usually managed medically with BP control, whereas a Type A dissection is a cardiac surgical emergency.
If not treated with emergent surgical correction, 50% of patients will die within 48 hours, and 75% will die in 2 weeks. This is the one true cardiac surgical emergency.
Almost always patients will have chest pain that may radiate to the back and have a “tearing” quality. Commonly patients are hypertensive, may have variable blood pressures in both arms, and can have a wide mediastinum on chest X-ray. Of course one can have a dissection even in the absence of any of these findings!
Diagnosis is usually made by a CT scan of the chest with contrast. In this case they were looking for CAD with a Cardiac coronary CTA which incidentally picked up the dissection, and gave us a free look at a gated cine sequence that is quite amazing! The diagnosis can also be made quite accurately with a TEE as well as an MRA.
Original case via Twitter from Dr. Alireza Maghsoudi
- Ali Haider MD, FACC - @yourheartdoc
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