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ui.case.use_touch_gestures
DICOM HelpSource: Local (us-east1-c)
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Demographics:
55 years old, Male
Indication:
Chest pain
Findings
Chest radiograph
- Mildly enlarged cardiopericardial silhouette with prominent contour of the aortic arch and descending thoracic aorta
CT
Chest
- Broad-based anterior outpouching from the distal descending thoracic aorta measuring 3 cm in craniocaudal dimension
- Diffuse mural thickening of the thoracic aorta with areas of crescentic relative hyperattenuation within the wall, particularly along the posterolateral aspect of the descending aorta
- Resultant ectasia of the aortic arch, measuring up to 3.8 cm in diameter, and aneurysmal dilation of the descending thoracic aorta, measuring up to 4 cm in diameter
- Moderate-sized, intermediate attenuation pericardial fluid
- Concentric left ventricular hypertrophy
- Moderate coronary artery calcification
- Small intermediate density left pleural effusion
- Mild dependent atelectasis
- Right upper lobe subcentimeter calcified granuloma
Upper abdomen
- No acute findings
MSK
- No acute findings
Diagnosis
Aortic intramural hematoma
Aortic pseudoaneurysm
Sample Report
Anteriorly-directed penetrating ulcer/pseudoaneurysm arising from the distal descending thoracic aorta with findings concerning for long-segment intramural hematoma involving the majority of the thoracic aorta. These findings raise concern for impending aortic rupture. Recommend surgical evaluation.
Moderate volume hemopericardium. Recommend correlation with clinical signs of cardiac tamponade.
Intermediate attenuation small left pleural effusion concerning for hemothorax.
Discussion
- Think about a penetrating ulcer as a focal pseudoaneurysm resulting from atherosclerotic disease
- Always make sure to look for evidence of an intramural hematoma, even when you do not have the luxury of precontrast images, because these patients are at risk for aortic rupture and warrant close monitoring at a minimum