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Pitfalls in the Diagnosis of Thoracic Aortic Dissection at CT Angiography¹

¹ From the Department of Radiological Sciences, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095-1721. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 26, 1999; revision requested May 17 and received July 1; accepted July 8. Address reprint requests to P.B. (e-mail: pbatra@mednet.ucla.edu).

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.

Index Terms: Aorta, CT, 94.12916, 94.74 • Aorta, dissection, 94.74, 94.93 • Aortography, 94.121

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