title: Missed diagnosis of limited ascending aortic dissection by multiple imaging modalities leading to fatal cardiac tamponade and aortic rupture.
abstract: Modern diagnostic imaging modalities for ascending aortic dissection include transesophageal echocardiography (TEE), computed tomography angiography (CTA), and magnetic imaging resonance (MRI). All have extremely high sensitivity and specificity for detection of an intimal flap to diagnose ascending aortic dissection. We present a case of fatal cardiac tamponade caused by a limited aortic dissection not detected by multiple imaging modalities. This may represent a class of aortic dissection variant that cannot be detected by conventional testing. A high index of suspicion should be maintained in the appropriate clinical setting and should prompt serial imaging and even consideration for preemptive surgical exploration.
authors.affiliation: Division of Cardiology, Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Manuchehry
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.forename: Swaminatha
authors.initials: S
authors.lastname: Gurudevan
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Marchevsky
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002305:Cardiac Tamponade / Q000150:complications* / Q000209:etiology / Q000628:therapy; D003287:Contrast Media; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020519:Pericardiocentesis; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media