EURORAD ESR

Case 15151

Iatrogenic aortic dissection following percutaneous coronary intervention

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 76 year(s)
 
 
  • Figure 1
    Early post-procedural (non ECG-gated) CT-angiography
     

    Axial precontrast images (a,b) showed dependent, strongly hyperattenuating (>2000 Hounsfield units, HU) material (*) in the aortic root and ascending aorta, corresponding to residual contrast medium (CM) injected...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Axial precontrast images (a,b) showed dependent, strongly hyperattenuating (>2000 Hounsfield units, HU) material (*) in the aortic root and ascending aorta, corresponding to residual contrast medium (CM) injected...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images c-d, oblique e, coronal f reconstructions) showed dissection of ascending aorta with opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm)...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images c-d, oblique e, coronal f reconstructions) showed dissection of ascending aorta with opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm)...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography oblique (e) and coronal (f) reconstructions showed extension of dissection along the ascending aorta: note opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography oblique (e) and coronal (f) reconstructions showed extension of dissection along the ascending aorta: note opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;
     
     
  • Figure 2
    Early follow-up (non ECG-gated) CT-angiography (48 hours)
     

    Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;
     
     
  • Figure 3
    Further follow-up (non ECG-gated) CT-angiography (10 days)
     

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;

    Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Angioplasty; Special Focus: Dissection;
     
     
Axial precontrast images (a,b) showed dependent, strongly hyperattenuating (>2000 Hounsfield units, HU) material (*) in the aortic root and ascending aorta, corresponding to residual contrast medium (CM) injected during coronary intervention.
 
Axial precontrast images (a,b) showed dependent, strongly hyperattenuating (>2000 Hounsfield units, HU) material (*) in the aortic root and ascending aorta, corresponding to residual contrast medium (CM) injected during coronary intervention.
 
Aortic CT-angiography (axial images c-d, oblique e, coronal f reconstructions) showed dissection of ascending aorta with opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm) with residual dependent CM(*).
 
Aortic CT-angiography (axial images c-d, oblique e, coronal f reconstructions) showed dissection of ascending aorta with opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm) with residual dependent CM(*).
 
Aortic CT-angiography oblique (e) and coronal (f) reconstructions showed extension of dissection along the ascending aorta: note opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm) with residual dependent CM (*).
 
Aortic CT-angiography oblique (e) and coronal (f) reconstructions showed extension of dissection along the ascending aorta: note opacified true lumen, compressed by non-perfused false lumen (arrowheads, max.thickness 21 mm) with residual dependent CM (*).
 
Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.
 
Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.
 
Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.
 
Precontrast images (axial a...c, oblique-sagittal d) showed decreased thickness (maximum 15mm) and attenuation (160 HU) of aortic false lumen (*) from CM dilution, with resolved compression of true lumen.
 
Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.
 
Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.
 
Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.
 
Aortic CT-angiography (axial images e-f, sagittal g and coronal h recontructions) confirmed decreased thickness of non-perfused false lumen (*) and normally opacified, non-compressed true lumen.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
Precontrast (a), CT-angiography (b...d) and venous-phase (e-f) images showed further decrease in thickness (1 cm) and attenuation (55 HU) of aortic false lumen (*), persistently non-perfused and extending approximately 8 cm along the ascending aorta.
 
 
 
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