PMC2698143_01
A 64-year-old woman with ascending aortic dissection presenting as secondary pulmonary hypertension.. A. An admission chest radiograph shows cardiomegaly with tortuous thoracic aorta, patch infiltration in right lower lobe, and blunting in both costophrenic angles. Mediastinal widening is not definite.. B. Preoperative transthoracic echocardiography shows an undulating intimal flap (arrow), dilated ascending aorta, and pericardial effusion (E).. C. Preoperative chest CT demonstrates intimal flap (arrow) of ascending aortic dissection (DeBakey type 2), pericardial effusion, and bilateral pleural effusions.. D. Chest CT image obtained 1.5 cm above C shows compression of the pulmonary artery by hematoma. Expanding dissection causes aneurysmal dilatation of ascending aorta (4 cm in diameter).. E. Schematic drawing in craniocaudal view with cross section of the ascending aorta and pulmonary artery. Right and left pulmonary arteries (rPA & lPA) are severely compressed by the hematoma (H), but coronary ostia are intact. The tear point is E situated at the posterolateral wall (arrow) of the ascending aorta.
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A chest X-ray taken on admission showed the presence of cardiomegaly without mediastinal widening, patch infiltration in the right lower lobe and blunting of the bilateral costophrenic angles (Fig. 1A). A follow-up transthoracic echocardiography taken 4 days later again showed a dilated ascending aorta and an intimal flap in the proximal ascending aorta (Fig. 1B). The computed tomography (CT) also showed the intimal flap of the ascending aortic dissection (DeBakey type II) and a large amount of hematoma compressing the pulmonary artery (Figs. 1C, D). There was a 2.5-cm sized transverse intimal tear in the posterolateral wall of the proximal ascending aorta (Fig. 1E).