False positive computed tomographic angiography for Stanford type A aortic dissection.

Area of Science:

• Cardiovascular Imaging
• Diagnostic Accuracy
• Thoracic Surgery

Background:

• Computed tomographic angiography (CTA) is the standard for ruling out acute aortic dissection.
• CTA is not infallible and can produce false-positive results.
• This case highlights potential pitfalls in CTA interpretation for aortic dissection.

Observation:

• A 52-year-old male presented with shortness of breath and severe hypertension.
• Initial CTA suggested Stanford Type A aortic dissection with a thrombosed false lumen.
• Intra-operative imaging and surgical inspection ruled out aortic dissection.

Findings:

• The false-positive CTA was attributed to non-uniform arterial contrast enhancement.
• Unrecognized biventricular dysfunction caused the atypical contrast enhancement pattern.
• Repeat CTA confirmed the absence of dissection, showing normal aortic anatomy.

Implications:

• Technical factors and patient-specific physiological conditions can lead to CTA misdiagnosis.
• Transesophageal echocardiography (TEE) and surgical inspection are crucial for confirming aortic dissection.
• Accurate diagnosis of acute aortic dissection requires careful correlation of imaging findings with clinical presentation and intra-operative data.