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Case of the Month 05/06

The NewYork-Presbyterian Emergency Department radiology teaching files database has been built up over the last several years. All cases in the database were seen at the NewYork-Presbyterian Emergency Department. This case is drawn from the database. Review the image and read the corresponding case before going on to the answers.

45 year old Hispanic male presents to ED complaining of several days of abdominal pain radiating to the back.

Q: What’s wrong with this picture?

View answer

This patient had a type A aortic dissection extending from the arch of the aorta into both iliac arteries.

Q: Which type of CT needs to be done to make this diagnosis? Are there any other imaging modalities which can be used?

View answer

The CT needs to be ordered with IV contrast. Otherwise the flap will not be visualized. Other imaging options include MRA and TEE however stability of patient should be strongly considered before sending him out of the department for such studies. You can see in the CT above of this patient done without contrast, the dissection is not seen.

Q: What is the normal diameter of the abdominal aorta? Would you expect it to be increased in size in this case?

View answer

The normal diameter of the infrarenal abdominal aorta is up to 3 cm. While it is possible to have a dissection which increases the caliber of the aorta, it is common for the diameter of the dissected aorta to be normal as in this case.