Case #28

Case #26

Chest radiograph

• Bulging contour of the ascending aorta
• Mild cardiomegaly
• Streaky bibasilar opacities
• Moderate-sized hiatal hernia

CT

• Chest
  • Acute Stanford type A aortic dissection with a patent communication between the true and false lumens just distal to the aortic valve
  • Retrograde extension of the dissection into the pericardium with a small hemopericardium and antegrade extension into the distal aortic arch and origins of the brachiocephalic and left common carotid arteries without significant true luminal narrowing
  • The false lumen is largely thrombosed with areas of internal hyperdensity on pre-contrast images consistent with organizing intramural hematomas
  • Resultant aneurysmal dilation of the ascending aorta measuring up to 7 cm in diameter
  • Mass effect from the dilated aortic root upon the right and left atria
  • Coronary arteries are patent and do not appear to be directly involved
  • Mild mass effect on the superior vena cava, which remains patent
  • Aortic atherosclerosis
  • Moderate coronary artery calcification
  • Tree-in-bud nodularity in the right upper lobe
  • Areas of scarring in the bilateral apices, right middle lobe, and lingula
  • Mild widespread bronchiectasis
  • Scattered areas of mucous plugging within bilateral bronchi
  • Bilateral micronodules
  • Small bilateral pleural effusions
  • Large hiatal hernia containing the majority of the stomach
• Upper abdomen
  • No acute findings
• MSK
  • Age-indeterminate T12 compression fracture with 50% height loss along the right aspect
  • Lytic lesion in the manubrium eroding through the anterior cortex
  • Osteopenia
  • Right breast mass measuring 3 x 3 cm abutting the pectoralis major muscle with overlying skin thickening

• Type A aortic dissection