CASE 1332 Published on 06.12.2001

Teaching Case

Section

Cardiovascular

Case Type

Clinical Cases

Authors

F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone

Patient

50 years, female

Categories

No Area of Interest ; Imaging Technique CT, CT ;

No Procedure ; No Special Focus ;

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Clinical History

Patient treated with a stent for an acute spontaneous dissection of the thoracic aorta.

Differential Diagnosis List

Residual aortic haematoma at the isthmus

Imaging Findings

The patient presented for intravascular treatment of an acute spontaneous dissection of the thoracic aorta (Stanford type B). The entry door was successfully closed with a stent and the false lumen was completely closed. At the 1-week follow-up study with spiral CT an abnormal finding was detected at the level of the isthmus on ventral profile of the aorta. Two options were considered: a residual aortic tear or a small haematoma modifying the profile of the aorta. Further follow-up studies demonstrated the static nature of the image, confirming the diagnosis.

Discussion

Acute aortic dissection is a worrying complication of many diseases, such as: atherosclerotic and degenerative disorders, bicuspid aortic valve, aortic coarctation, pregnancy, connective tissue disorders (Marfan, Ehlers-Danlos), skeletal abnormalities (scoliosis, pectus), mycotic aneurysm, Takayasu arteritis, and aortic traumatic laceration.

Intravascular treatment is becoming a minimally invasive option that can be used even in patients with extensive involvement, for example affecting the whole thoracic aorta. Short- and mid-term complications of the stenting procedure are reported, including: collapse, torsion, mobilisation, kneeing, and thrombosis.

In this case a complication without severe consequences is described. The haematoma created an image that could be misinterpreted as a residual tear. Follow-up examination with spiral CT and clinical examination demonstrated the static nature of the image. Careful follow-up is needed in patients with this complication.

References

[1] Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ, Miller GL, Summa JA. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am J Roentgenol. 2001;176(5):1267-72. (PMID: 11312193)

[2] Gavant ML, Menke PG, Fabian T, Flick PA, Graney MJ, Gold RE. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 1995;197(1):125-33. (PMID: 7568809)

[3] Durham RM, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld WB, Herr DJ,
Shapiro MJ, Mazuski JE, Salimi Z, Sundaram M. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994;220(5):699-704. (PMID: 7979620)

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