Type A Aortic Disection with Pericardial Hematoma

CT chest: Type A Aortic disection with rupture into pericardial space. Note the intimal flap in the ascending aorta and the intermediate density blood in the pericardial space.
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Pathophysiology
tear in intimal lining
ascending (65%)
arch (10%)
descending (20%)

Why?
collagen elastin abnormality
cystic medial necrosis
Intramural hematoma
No intimal tear
medial hemorrhage

Who?
HTN
vasculitis
50-70 yo males >females
Diagnosis
CT scan
sensitivity 96-100%
specificity 96-100%
Ptifalls- motion thru aortic root (can ecg gate)
renal insufficiency
contrast allergy
MRI
sens= 98%
spec= 98%
Pitfalls long study not for unstable patient
no iodine
less motion artifact if ecg gated
can quantitiate aortic insufficiency
Complications
Death: 25% first 24 hrs
50% first week
Aortic insufficiency
pericardial hematoma and tamponade
MI
branch artery occlusion
rupture leak
Famous deaths
King George II
John Ritter