Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography.

Abstract

Two hundred seventy-five computed tomographic (CT) angiograms of the thoracic aorta were obtained over a period of approximately 4 years in patients with suspected or known aortic dissection. In all cases, unenhanced images were initially obtained, followed by contrast material-enhanced images. A variety of pitfalls were encountered that mimicked aortic dissection. These pitfalls were attributable to technical factors (eg, improper timing of contrast material administration relative to image acquisition); streak artifacts generated by high-attenuation material, high-contrast interfaces, or cardiac motion; periaortic structures (eg, aortic arch branches, mediastinal veins, pericardial recess, thymus, atelectasis, pleural thickening or effusion adjacent to the aorta); aortic wall motion and normal aortic sinuses; aortic variations such as congenital ductus diverticulum and acquired aortic aneurysm with thrombus; and penetrating atherosclerotic ulcer. Although several of these pitfalls are easy to recognize and therefore unlikely to present a diagnostic problem, others are potentially confusing. Familiarity with these common pitfalls, coupled with a knowledge of normal intrathoracic anatomy, will facilitate recognition of true aortic dissection and help avoid misdiagnosis at thoracic aortic CT angiography.

• Authors: P Batra, B Bigoni, J Manning, D R Aberle, K Brown, E Hart, J Goldin
• Journal: Radiographics : a review publication of the Radiological Society of North America, Inc (Radiographics) 2000 Mar-Apr Vol. 20 Issue 2 Pg. 309-20 ISSN: 0271-5333 [Print] United States
• PMID: 10715333 (Publication Type: Journal Article)

Chemical References

• Contrast Media

Topics

• Aortic Dissection (diagnostic imaging)
• Aorta, Thoracic (abnormalities, diagnostic imaging)
• Aortic Aneurysm, Thoracic (diagnostic imaging)
• Aortic Diseases (congenital)
• Aortography (methods)
• Arteriosclerosis (diagnostic imaging)
• Artifacts
• Contrast Media (administration & dosage)
• Diagnosis, Differential
• Diverticulum (congenital)
• Heart (diagnostic imaging)
• Humans
• Image Processing, Computer-Assisted
• Mediastinum (blood supply)
• Myocardial Contraction (physiology)
• Pericardium (diagnostic imaging)
• Pleura (diagnostic imaging)
• Pleural Effusion (diagnostic imaging)
• Pulmonary Atelectasis (diagnostic imaging)
• Radiographic Image Enhancement
• Thrombosis (diagnostic imaging)
• Thymus Gland (diagnostic imaging)
• Tomography, X-Ray Computed (methods)
• Veins