[Acute aortic dissection without opacification of the false lumen on the initial aortogram: a case report]

A 50-year-old woman was admitted to the intensive care unit 40 min after the onset of severe chest and back pain with consciousness loss. Emergency computed tomography and aortography demonstrated an acute type A dissection without opacification of the false lumen. The patient was initially treated with antihypertensive drugs. Recurrent back pain and bilateral pleural effusion appeared 3 days after onset of the pain. Both the right radial and carotid pulses were reduced. Emergent operation was performed when computed tomography and aortography repeated 5 days after onset of the pain demonstrated the intimal flap in the ascending aorta with the opacified false lumen. The site of intimal tear in the proximal arch was resected and a 26 mm Dacron graft was inserted during deep hypothermia and circulatory arrest. The postoperative course was uneventful.