Findings
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 substantial true luminal narrowing
- The false lumen is largely thrombosed with areas of internal hyperattenuation on pre-contrast images consistent with organizing intramural hematomas
- Resultant aneurysmal dilation of the ascending aorta measuring up to 6.5 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
Diagnosis
Type A aortic dissection
Sample Report
Type A aortic dissection extending from the aortic root to the distal arch with associated small hemopericardium and aneurysmal dilation of the ascending aorta measuring up to 7 cm in diameter. The false lumen is largely thrombosed with extensive intramural hematoma extending into the origins of the brachiocephalic and left common carotid arteries, which remain widely patent. Recommend surgical evaluation.
Tree-in-bud nodularity in the right upper lobe and areas of scarring with bronchiectasis are suggestive of a chronic atypical infection, such as mycobacterium avium intercellulare.
Right breast mass concerning for primary breast carcinoma. Possible lytic metastasis in the manubrium. Recommend further evaluation by diagnostic mammography and possible nuclear medicine bone scan when the patient's condition permits.
Age-indeterminate, though favored remote, T12 compression fracture. Recommend correlation with point tenderness at this location.
Small pleural effusions.
Large hiatal hernia with intrathoracic stomach.
Discussion