Washington University School of Medicine, St. Louis, MO, USA.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box, St. Louis, MO, 8131, USA.
Emerg Radiol. 2023 Dec;30(6):801-805. doi: 10.1007/s10140-023-02173-2. Epub 2023 Oct 6.
Limited type A aortic dissection (LTAAD) is a rare subtype of dissection that is confined within a well-defined border of the ascending aorta. These dissections may occur in the remaining native portion of the aortic root following aortic root replacement and can be complicated by malperfusion syndrome-a syndrome where dissections compromise the aortic branches and lead to end-organ ischemia. Because LTAAD is confined within the ascending aorta, malperfusion syndrome may preferentially affect the coronary arteries resulting in coronary malperfusion, myocardial infarction, and increased mortality. We report a case of LTAAD and malperfusion syndrome of the left main coronary artery which resulted in inadequate contrast opacification of the aorta and failure of the dissection protocol to trigger on computed tomography (CT). Upon further evaluation of the situation, the radiologist oversaw the manual triggering of CT acquisitions which yielded an actionable CT at 6 minutes post-contrast and real-time visualization of the patient's developing cardiac ischemia.
局限性升主动脉夹层（LTAAD）是一种罕见的夹层亚型，局限于升主动脉的明确边界内。这些夹层可能发生在主动脉根部置换后剩余的原生主动脉根部部分，并可能因灌注不良综合征而复杂化-夹层会影响主动脉分支并导致终末器官缺血。由于 LTAAD 局限于升主动脉，灌注不良综合征可能优先影响冠状动脉，导致冠状动脉灌注不良、心肌梗死和死亡率增加。我们报告了一例 LTAAD 和左主干冠状动脉灌注不良综合征，导致主动脉对比度不足，并且 CT 扫描未触发夹层协议。在进一步评估这种情况时，放射科医生监督了 CT 采集的手动触发，在造影后 6 分钟获得了可操作的 CT，并实时观察到患者的心脏缺血情况。
