CASE 11037 Published on 25.08.2013

Acute aortic dissection

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Naveen Bhatt

King's College London
Patient

42 years, male

Categories
Area of Interest Cardiovascular system, Arteries / Aorta ; Imaging Technique CT-Angiography
Clinical History
Young cyclist brought in by ambulance with history of collapse while cycling to work 20 minutes before. Blood pressure was unrecordable at presentation and patient was intubated on way to A& E.
Imaging Findings
CT CAP angiogram shows double lumen in thoracic, abdominal aorta and both carotid arteries.
Discussion
Patient was brought to CT scanner for a CT head which was normal. Due to non-recordable blood pressure it was decided to perform CT angiogram to exclude vascular causes like dissection or aneurysmal leak. A body CT showed Stanford A dissection extending from aortic root to just below the renal arteries. While vascular team was booking a theatre slot, the study was extended to include neck vessels due to the radiological suspicion of involvement of the left carotid artery. CT neck angiography showed bilateral carotid artery dissection. Body CT showed hypodense liver and right kidney suggesting ischaemia as the origins of these vessels were involved in the dissection flap.

Patient was transferred from CT scanner to the theatre. Following discussion with interventional radiology consultants, a consensus for surgical management was reached due to a timely diagnosis.

The take home message of this case is the importance of an urgent CT scan especially if a patient presents within an hour. The other important message is not to limit oneself to following standard practice of classification of ascending and descending aortic involvement but to also carefully look for all major aortic branches such as in this case where there was involvement of both carotid arteries with life threatening consequences.
Differential Diagnosis List
Acute aortic dissection
Marfans syndrome
Chronic dissection
Final Diagnosis
Acute aortic dissection
Case information
URL: https://www.eurorad.org/case/11037
DOI: 10.1594/EURORAD/CASE.11037
ISSN: 1563-4086