Case of The Week – Chest Pain

Case of The Week – Chest Pain

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Arterial phase contrast enhanced scans show aortic dissection with intimal flap noted in the thoracic aorta commencing just distal to the left subclavian artery branch point extending down beyond the renal arteries. The maximum transverse diameter measures 55mm just distal to the subclavian artery branch point. Significant hematoma noted around the descending thoracic aorta.  Moderate left pleural effusion (~ 320ml) with extravasation of contrast into the effusion, indicative of leakage of the dissection. No pericardial effusion is demonstrated. The right lung is normal. The left chest tube is anterior and superior to the effusion.

The true lumen is smaller than the false lumen. The superior mesenteric artery and right renal artery branches are from the true lumen. The coeliac trunk and left renal artery originates from the false lumen.

Incidentally noted is variant branching of the aortic arch (common branch dividing into brachiocephalic and left common carotid artery).

There is severe cardiomegaly due to severe left ventricular wall hypertrophy.

No pneumothorax demonstrated.  No abnormality in the anterior chest wall identified, to suggest trauma. No bony injury identified.

No free fluid in the abdomen to suggest leakage.

Within the limitations of the study, the imaged liver, spleen, pancreas and right kidney are unremarkable.

Stanford Type B aortic dissection with intimal flap seen extending beyond the kidneys and moderate left hemothorax.

Requesting physician informed at the time of reporting.

Reference: https://pubs.rsna.org/doi/10.1148/rg.302095104

Dr. Bashiru Jimah

Ghana Association of Radiologists (GAR) was inaugurated in 2009, at a time when there were only 16 radiologists in three out of ten regions in Ghana.

This Post Has 2 Comments

  1. Where the iliac arteries involved?

  2. I see the left renal artery was arising from the false lumen, what was the outcome for this patient?.
    Did he or she have any intervention done.
    What was the underlying aetiology as well.

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