PMC8673863_01
Axial-view preoperative CT without contrast. Massive pericardial effusion is seen. Dissection is suspected in the ascending aorta (black arrow).
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No abnormalities were seen on head CT, but massive pericardial effusion was demonstrated on CT of the chest and dissection was suspected in the ascending aorta (Figure 1).
(a) Axial-view preoperative contrast-enhanced CT. Dissection is seen in the ascending aorta. (b) A 3D reconstruction of preoperative CT. Dissected and dilated ascending aorta with maximal diameter of 44 mm is demonstrated.
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Contrast-enhanced CT revealed an aortic dissection localized at the ascending aorta with massive pericardial effusion (Figure 2(a)). A three-dimensional (3D) reconstruction of preoperative CT demonstrated dissected and dilated ascending aorta with a maximal diameter of 44 mm (Figure 2(b)).
Intraoperative findings. (a) Hematoma is detected on the pulmonary artery side of the ascending aorta. (b) Intimal tears were present on the noncoronary sinus of Valsalva and the distal part of ascending aorta located at the lesser curvature.
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After opening the pericardium, massive hemorrhagic pericardial effusion was evacuated and hematoma was revealed on the pulmonary artery side of the ascending aorta (Figure 3(a)). Intimal tears were present on the noncoronary sinus of Valsalva and the distal part of ascending aorta located at the lesser curvature, and the ostia of the coronary arteries were intact (Figure 3(b)).
Pathological findings of the aortic wall (elastica van Gieson stain). The yellow arrow points to hemorrhage in the adventitia.
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Pathological findings of the mid-part of ascending aortic wall showed hemorrhage and fibrosis in the adventitia, whereas no abnormality was seen in the media (Figure 4).