PMC6881564_01
EKG showing occasional ventricular premature complexes, left ventricular hypertrophy, with nonspecific ST-segment, T-wave changes.
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fig1
Electrocardiogram (EKG) showed sinus rate at 63 bpm with occasional ventricular premature complexes, left ventricular hypertrophy and nonspecific ST-segment, T-wave changes (Figure 1).
CXR showing widened mediastinum (arrows), enlarged cardiomediastinal silhouette and longitudinal retrocardiac opacity.
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fig2
The chest X-ray (CXR) showed a widened mediastinum, enlarged cardiomediastinal silhouette, and longitudinal retrocardiac opacity which was noted by the radiologist to possibly reflect a thoracic aortic aneurysm (Figure 2).
Axial CT image of the thorax without contrast showing aneurysmal dilatation (arrow) of the ascending thoracic aorta.
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fig3
The CT showed aneurysmal dilatation of the ascending thoracic aorta, measuring up to 4.5 cm in the axial image (Figure 3).
Parasternal long axis view showing the dissection flap (arrows) in the ascending aorta.
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fig4
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).
Parasternal long axis view showing aortic insufficiency (arrows).
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fig5
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).
Parasternal long axis view showing the ascending aortic aneurysm.
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fig6
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).
Suprasternal notch view showing the dissection flap extending to the aortic arch (arrow).
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fig7
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).
Color Doppler helps in appreciating the true lumen (arrows) from the false lumen.
CRIRA2019-6545472.008.jpg
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fig8
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).
Parasternal long axis view showing dissection flap prolapsing (arrow) into the left ventricular outflow tract causing aortic insufficiency.
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fig9
From the data above (aortic dissection detection risk score of 1), and given the fact that the Troponin I levels were uptrending, (1.340 ng/mL-1.430 ng/mL), evaluation for dissection was undertaken initially utilizing a bedside transthoracic echocardiogram (TTE) which identified an ascending aortic/aortic root aneurysm with a dissection flap (Figures 4-9).