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Case Reports
. 2020 Mar 5;1(2):132-136.
doi: 10.1002/emp2.12026. eCollection 2020 Apr.

Type A aortic dissection mimicking saddle pulmonary embolism on CT imaging

Woon H Chong  1 , Biplab K Saha  2 , Christopher Wang  1 , Scott Beegle  1
Affiliations
Case Reports

Type A aortic dissection mimicking saddle pulmonary embolism on CT imaging

Woon H Chong et al. J Am Coll Emerg Physicians Open. .

Abstract

Type A aortic dissection is an uncommon cause of chest pain that carries a high morbidity and mortality rate. A previous history of hypertension and coronary artery bypass grating (CABG) are recognized risk factors for Type A aortic dissection. We present a case of an elderly man who presents with acute onset chest pain and was found to have an acute ruptured Type A aortic dissection that has a "saddle pulmonary embolism"-like appearance on computed tomography (CT) imaging. We also describe the clinical, laboratory, and radiological workup done leading up to the diagnosis of Type A aortic dissection in the emergency setting.

Keywords: Aortic Dissection Detection Risk Score (ADD‐RS); Mediastinal Hematoma; Point of Care Ultrasound (POCUS); Pulmonary Artery Compression; Type A Aortic Dissection.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
(A) Transthoracic echocardiogram parasternal long view demonstrating dilated ascending aorta (AA). (B) Transesophageal echocardiogram mid esophageal view. (C) Transesophageal echocardiogram transverse cut of ascending aorta. white arrow shows location of intimal flap. AA, aortic aneurysm; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TL, true lumen
FIGURE 2
FIGURE 2
CT angiography of thoracic aorta showing acute Type A aortic dissection. Axial view (A and B), coronal view (C), and sagittal view (D). White arrows show mediastinal hematoma that compresses and obliterates 90% of the bifurcation of pulmonary artery (A–D), red arrows show location of pulmonary artery in relation to mediastinal hematoma, and yellow arrows show location of false lumen (A, B, and D). Mediastinal hematoma extrinsically compressing the pulmonary bifurcation (A–C) giving it a “saddle pulmonary embolism”‐like appearance on CT. Dissection involving the aortic root (D) with defect in posterior wall of proximal ascending aorta forming mediastinal hematoma
FIGURE 3
FIGURE 3
CT angiography of chest. Axial view (A) and coronal view (B) shows mediastinal hematoma with compression of pulmonary artery (red arrow) from ruptured Type A aortic dissection that mimics a "saddle pulmonary embolism" like appearance. The similarities are highlighted when comparing it to an actual saddle pulmonary embolism case seen in CT chest axial view (C) and coronal view (D)
See this image and copyright information in PMC

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