title: Pitfalls in suspected acute aortic syndrome: impact of appropriate and if required repeated imaging.
abstract: The incidence of acute aortic syndrome is low, but the spontaneous course is often life-threatening. Adequate ECG-gated imaging is fundamental within the diagnostic workup. We here report a case of a 53-year-old man presenting with atypical chest pain, slight increase of D dimers at admission, and extended diameter of the ascending aorta accompanied by mild aortic regurgitation. Interpretation of an initial contrast-enhanced computed tomography was false negative due to inadequate gating and motion artifacts, thereby judging a tiny contrast signal in the left anterior quadrant of the ascending aorta as a pseudointimal flap. By hazard, cardiac magnetic resonance imaging demonstrated an ulcer-like lesion superior to the aortic root, leading to aortic surgery at the last moment. As sensitivity of imaging is not 100%, this example underlines that second imaging studies might be necessary if the first imaging is negative, but the clinical suspicion still remains high.
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, 48149 Münster, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Meier
authors.affiliation: Department of Angiology, Arnsberg Medical Center, 59759 Arnsberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Lichtenberg
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, 48149 Münster, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Lebiedz
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, 59759 Arnsberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Breuckmann