PMC6002801_01
Anterior-posterior chest X-ray. A: At presentation showing enlargement of the mediastinum. B: On day 11 of hospitalisation showing bilateral interstitial heterogeneous opacities.
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F1
Chest X-ray (Fig. 1A) showed enlargement of the mediastinum with cuffing of the aortic knob. A repeat chest X-ray (Fig. 1B) showed bilateral interstitial heterogeneous opacities.
ECG at presentation showing non-specific ST-segment changes consistent with sub-epicardial ischaemia in the inferior and apico-lateral leads.
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F2
ECG (Fig. 2) at our unit showed a normal sinus rhythm, normal QRS axis with sub-epicardial ischaemia in the inferior and apico-lateral leads. Echocardiography (Fig. 3) showed a dilated left atrium, good left ventricular systolic function (ejection fraction 72%), and severe aortic insufficiency with dilatation of the aortic root and ascending aorta (44 mm).
Echocardiography showing dilatation of the ascending aorta.
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F3
ECG (Fig. 2) at our unit showed a normal sinus rhythm, normal QRS axis with sub-epicardial ischaemia in the inferior and apico-lateral leads. Echocardiography (Fig. 3) showed a dilated left atrium, good left ventricular systolic function (ejection fraction 72%), and severe aortic insufficiency with dilatation of the aortic root and ascending aorta (44 mm).
Contrast-enhanced CT angiogram of the thorax showing aortic dissection extending to the left renal (green arrow), iliac (yellow arrow) and superior mesenteric (red arrow) arteries and causing splenic infarction (blue arrow).
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F4
Contrast-enhanced CT (CECT) angiogram of the thorax (Fig. 4) showed dissection of the aorta from the ascending aorta to the iliac arteries, including the coeliac trunk and left renal artery, and causing splenic infarction.