IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Aortic dissection with rupture into the pericardial sac

Case contributed by J. Ray Ballinger
Diagnosis certain

Presentation

History of hypertension and hypercholesterolemia found unconscious in nursing home.

Patient Data

Age: 80 years
Gender: Male

The AP view of the chest shows widening of the mediastinum and cardiomegaly.


The contrast enhanced CT images show a Stanford type A dissection of the ascending aorta extending retrograde down to the aortic root and rupturing into the pericardial sac causing tamponade. 

Case Discussion

Aortic dissection is associated with hypertension, Marfan syndrome and a bicuspid aortic valve. It commonly extends antegrade from either close to the aortic root (Type A) or just beyond the left subclavian artery (Type B). Less common is retrograde extension with rupture into the pericardial sac. There is about a 80% mortality within the first 2 weeks and an operative mortality of 25%. Management includes controlling hypertension. Reasons for surgical management include an enlarging aorta and, as in this case, pericardial tamponade. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.