False positive computed tomographic angiography for Stanford type A aortic dissection
Background: Computed tomographic angiography (CTA) has emerged as the defacto imaging test to rule out acute aortic dissection; however, it is not without flaws. We report a case of a false-positive CTA with respect to Stanford Type A aortic dissection. Case: A 52 year-old male presented with sudden...
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| Format: | Article |
| Language: | English |
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Elsevier
2015-12-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S193004331530008X |
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| author | Murad F. Bandali, MD Muhammed A. Hatem, MBChB, MRes Jehangir J. Appoo, MD, FRCSC Stuart J. Hutchison, MD, FRCPC Jason K. Wong, MD, FRCPC |
| author_facet | Murad F. Bandali, MD Muhammed A. Hatem, MBChB, MRes Jehangir J. Appoo, MD, FRCSC Stuart J. Hutchison, MD, FRCPC Jason K. Wong, MD, FRCPC |
| author_sort | Murad F. Bandali, MD |
| collection | DOAJ |
| description | Background: Computed tomographic angiography (CTA) has emerged as the defacto imaging test to rule out acute aortic dissection; however, it is not without flaws. We report a case of a false-positive CTA with respect to Stanford Type A aortic dissection.
Case: A 52 year-old male presented with sudden onset shortness of breath. He denied chest pain. Due to severe hypertension and an Emergency Department bedside ultrasound suggesting an intimal flap in the aorta, CTA was requested to better assess the ascending aorta and was interpreted as consistent with Stanford Type A aortic dissection with thrombosis of the false lumen in the ascending aorta. However, intra-operative imaging (TEE and epi-aortic scanning) did not identify an intimal flap or dissection, and neither did definitive surgical inspection of the aorta. The suspected aortic dissection and thrombosed false lumen were not visualized on repeat CTA two days later.
Discussion: False positive diagnosis of Stanford Type A aortic dissection on CTA can be the result of technical factors, streak artifacts, motion artifacts, and periaortic structures. In this case, non-uniform arterial contrast enhancement secondary to unrecognized biventricular dysfunction resulted in the false positive CTA appearance of an intimal flap and mural thrombus. Intra-operative TEE and epi-aortic scanning were proven correct in excluding aortic dissection by the standard of definitive surgical inspection of the aorta. |
| first_indexed | 2024-12-13T07:01:00Z |
| format | Article |
| id | doaj.art-e11c112c09be44cf864d49a1a538ba00 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-12-13T07:01:00Z |
| publishDate | 2015-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-e11c112c09be44cf864d49a1a538ba002022-12-21T23:55:57ZengElsevierRadiology Case Reports1930-04332015-12-01104313510.1016/j.radcr.2015.06.010False positive computed tomographic angiography for Stanford type A aortic dissectionMurad F. Bandali, MD0Muhammed A. Hatem, MBChB, MRes1Jehangir J. Appoo, MD, FRCSC2Stuart J. Hutchison, MD, FRCPC3Jason K. Wong, MD, FRCPC4Department of Diagnostic Radiology, University of Calgary, Calgary, Alberta, CanadaDepartment of Diagnostic Radiology, University of Calgary, Calgary, Alberta, CanadaDivision of Cardiac Surgery, University of Calgary, Calgary, Alberta, CanadaDepartment of Cardiology, University of Calgary, Calgary, Alberta, CanadaDepartment of Diagnostic Radiology, University of Calgary, Calgary, Alberta, CanadaBackground: Computed tomographic angiography (CTA) has emerged as the defacto imaging test to rule out acute aortic dissection; however, it is not without flaws. We report a case of a false-positive CTA with respect to Stanford Type A aortic dissection. Case: A 52 year-old male presented with sudden onset shortness of breath. He denied chest pain. Due to severe hypertension and an Emergency Department bedside ultrasound suggesting an intimal flap in the aorta, CTA was requested to better assess the ascending aorta and was interpreted as consistent with Stanford Type A aortic dissection with thrombosis of the false lumen in the ascending aorta. However, intra-operative imaging (TEE and epi-aortic scanning) did not identify an intimal flap or dissection, and neither did definitive surgical inspection of the aorta. The suspected aortic dissection and thrombosed false lumen were not visualized on repeat CTA two days later. Discussion: False positive diagnosis of Stanford Type A aortic dissection on CTA can be the result of technical factors, streak artifacts, motion artifacts, and periaortic structures. In this case, non-uniform arterial contrast enhancement secondary to unrecognized biventricular dysfunction resulted in the false positive CTA appearance of an intimal flap and mural thrombus. Intra-operative TEE and epi-aortic scanning were proven correct in excluding aortic dissection by the standard of definitive surgical inspection of the aorta.http://www.sciencedirect.com/science/article/pii/S193004331530008XStanford AComputed tomographyDissectionAortaFalse positive |
| spellingShingle | Murad F. Bandali, MD Muhammed A. Hatem, MBChB, MRes Jehangir J. Appoo, MD, FRCSC Stuart J. Hutchison, MD, FRCPC Jason K. Wong, MD, FRCPC False positive computed tomographic angiography for Stanford type A aortic dissection Radiology Case Reports Stanford A Computed tomography Dissection Aorta False positive |
| title | False positive computed tomographic angiography for Stanford type A aortic dissection |
| title_full | False positive computed tomographic angiography for Stanford type A aortic dissection |
| title_fullStr | False positive computed tomographic angiography for Stanford type A aortic dissection |
| title_full_unstemmed | False positive computed tomographic angiography for Stanford type A aortic dissection |
| title_short | False positive computed tomographic angiography for Stanford type A aortic dissection |
| title_sort | false positive computed tomographic angiography for stanford type a aortic dissection |
| topic | Stanford A Computed tomography Dissection Aorta False positive |
| url | http://www.sciencedirect.com/science/article/pii/S193004331530008X |
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