Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography.
Two hundred seventy-five computed tomographic (CT) angiograms of the thoracic aorta were obtained over a period of approximately 4 years in patients with suspected or known aortic dissection. In all cases, unenhanced images were initially obtained, followed by contrast material-enhanced images. A variety of pitfalls were encountered that mimicked aortic dissection. These pitfalls were attributable to technical factors (eg, improper timing of contrast material administration relative to image acquisition); streak artifacts generated by high-attenuation material, high-contrast interfaces, or cardiac motion; periaortic structures (eg, aortic arch branches, mediastinal veins, pericardial recess, thymus, atelectasis, pleural thickening or effusion adjacent to the aorta); aortic wall motion and normal aortic sinuses; aortic variations such as congenital ductus diverticulum and acquired aortic aneurysm with thrombus; and penetrating atherosclerotic ulcer. Although several of these pitfalls are easy to recognize and therefore unlikely to present a diagnostic problem, others are potentially confusing. Familiarity with these common pitfalls, coupled with a knowledge of normal intrathoracic anatomy, will facilitate recognition of true aortic dissection and help avoid misdiagnosis at thoracic aortic CT angiography.
Batra
P
P
Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA 90095-1721, USA. pbatra@mednet.ucla.edu
Bigoni
B
B
Manning
J
J
Aberle
D R
DR
Brown
K
K
Hart
E
E
Goldin
J
J
D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000151:congenital; D001027:Aortography / Q000379:methods*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D016477:Artifacts; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000151:congenital; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008482:Mediastinum / Q000098:blood supply; D009200:Myocardial Contraction / Q000502:physiology; D010496:Pericardium / Q000000981:diagnostic imaging; D010994:Pleura / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement; D013927:Thrombosis / Q000000981:diagnostic imaging; D013950:Thymus Gland / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014680:Veins
D003287:Contrast Media