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Pitfalls of CT diagnosis of aortic dissection: nonvisualized intimal flap in the ascending aorta or aortic arch
T Yamaguchi1, K Kuroki, Y Ohyama
1Department of Radiology, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Japan.
Abstract:
We describe our experience with initial CT scans that failed to demonstrate an intimal flap in the ascending aorta or aortic arch that was subsequently identified on echocardiography, angiography, or MR imaging in four patients. This problem was presumably caused by the flailing motion of a thin intimal flap and localized small dissection in the ascending aorta, or transverse intimal flap within the aortic arch. Radiologists should be aware of this pitfall in CT diagnostic imaging.
Insights
Initial CT scans may miss aortic intimal flaps due to motion, leading to delayed diagnosis. Awareness of this CT imaging pitfall is crucial for accurate aortic dissection detection.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Thoracic Imaging
Background:
- Computed Tomography (CT) is a primary modality for diagnosing aortic pathologies.
- Aortic dissection diagnosis relies on identifying intimal flaps.
Observation:
- Four cases are presented where initial CT scans failed to detect intimal flaps.
- Subsequent echocardiography, angiography, or MR imaging confirmed the intimal flaps.
Findings:
- The missed intimal flaps were attributed to the flailing motion of thin flaps in the ascending aorta or transverse flaps in the aortic arch.
- CT imaging limitations can obscure subtle intimal flap visualization.
Implications:
- Radiologists must recognize potential CT diagnostic pitfalls for aortic dissection.
- Consideration of alternative imaging modalities is essential when CT findings are equivocal.
- Improved awareness can enhance the timely and accurate diagnosis of aortic dissections.