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Cardiac computed tomography in the emergency department: A patient with acute epigastric pain
Journal of Cardiovascular Computed Tomography (2010) 4, 142–143
Images in Cardiovascular CT
Cardiac computed tomography in the emergency department: A patient with acute epigastric pain Vahid Etezadi, MDa, Constantino Pena, MDa, Angelo La-Pietra, MDb, Jack A. Ziffer, MDa, Barry T. Katzen, MDa, Ricardo C. Cury, MDa,* a
Cardiovascular MR and CT Program, Department of Radiology and bDepartment of Cardiothoracic Surgery, Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA KEYWORDS: Aortic dissection; Cardiac imaging; Coronary CT angiography
Abstract. We report the application of coronary CT angiogram in urgent assessment of a patient presenting to the emergency department with acute and nonspecific cardiothoracic symptoms. Ó 2010 Society of Cardiovascular Computed Tomography. All rights reserved.
Figure 1 Coronary CTA shows an intimal flap within the ascending and descending aorta (black arrow heads), confirming the diagnosis of type A aortic dissection, pericardial hematoma (white arrows), and extravasation of the contrast into the mediastinum (black arrow) with a small tear in the medial aspect of the ascending aorta.
Conflict of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] Submitted October 5, 2009. Accepted for publication January 9, 2010.
Figure 2 Axial coronary CTA shows patent coronary arteries with no evidence of dissection. The hematoma is tracking into the right atrioventricular groove (white arrows) surrounding the RCA. LAD, left anterior descending; LCX, left circumflex artery; RCA, right coronary artery.
A 51-year-old man with history of alcohol abuse, hypertension, congestive heart failure, and morbid obesity presented to the emergency department complaining of sudden onset of epigastric pain and tenderness radiating to
1934-5925/$ -see front matter Ó 2010 Society of Cardiovascular Computed Tomography. All rights reserved. doi:10.1016/j.jcct.2010.01.012
Etezadi et al
Cardiac CT for acute epigastric pain
143 his jaw. The pain was partially relieved with nitroglycerine and aspirin. Blood pressure was similar in both upper extremities. The electrocardiograms were normal, and cardiac enzymes were mildly elevated. Portable chest x-ray showed an enlarged cardiac silhouette and a tortuous and elongated aorta. A 64-row prospectively triggered coronary CT angiography (CTA) showed a type A aortic dissection with a small tear in the mid ascending aorta and extravasation of the contrast into the mediastinum and pericardium. An unusual finding included the presence of a moderate amount of hematoma surrounding coronary arteries at the right atrioventricular groove (Fig. 1 and Fig. 2). Coronary CTA showed mild nonobstructive coronary artery disease. The patient survived after successful emergency repair of the ruptured type A aortic dissection (Fig. 3). This case highlights the application of 64-slice multidetector CT technology in patients presenting with acute chest pain with simultaneously assessment of the aorta and coronary arteries with high accuracy and provides an example of using this technique not only for the diagnostic purpose but also for thorough anatomic analysis before any possible cardiothoracic intervention.1,2
References
Figure 3 Intraoperative pictures show the clot covering the rupture (white arrow) in the mid ascending aorta (A), confirming the findings of cardiac CT and the dissected intimal flap (B).
1. Hoffmann U, Ferencik M, Cury RC, Pena AJ: Coronary CT angiography. J Nucl Med. 2006;47:797–806. 2. Cury RC, Feutchner G, Pena CS, Janowitz WR, Katzen BT, Ziffer JA: Acute chest pain imaging in the emergency department with cardiac computed tomography angiography. J Nucl Cardiol. 2008;15:564–75.
Images in Cardiovascular CT
Cardiac computed tomography in the emergency department: A patient with acute epigastric pain Vahid Etezadi, MDa, Constantino Pena, MDa, Angelo La-Pietra, MDb, Jack A. Ziffer, MDa, Barry T. Katzen, MDa, Ricardo C. Cury, MDa,* a
Cardiovascular MR and CT Program, Department of Radiology and bDepartment of Cardiothoracic Surgery, Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA KEYWORDS: Aortic dissection; Cardiac imaging; Coronary CT angiography
Abstract. We report the application of coronary CT angiogram in urgent assessment of a patient presenting to the emergency department with acute and nonspecific cardiothoracic symptoms. Ó 2010 Society of Cardiovascular Computed Tomography. All rights reserved.
Figure 1 Coronary CTA shows an intimal flap within the ascending and descending aorta (black arrow heads), confirming the diagnosis of type A aortic dissection, pericardial hematoma (white arrows), and extravasation of the contrast into the mediastinum (black arrow) with a small tear in the medial aspect of the ascending aorta.
Conflict of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] Submitted October 5, 2009. Accepted for publication January 9, 2010.
Figure 2 Axial coronary CTA shows patent coronary arteries with no evidence of dissection. The hematoma is tracking into the right atrioventricular groove (white arrows) surrounding the RCA. LAD, left anterior descending; LCX, left circumflex artery; RCA, right coronary artery.
A 51-year-old man with history of alcohol abuse, hypertension, congestive heart failure, and morbid obesity presented to the emergency department complaining of sudden onset of epigastric pain and tenderness radiating to
1934-5925/$ -see front matter Ó 2010 Society of Cardiovascular Computed Tomography. All rights reserved. doi:10.1016/j.jcct.2010.01.012
Etezadi et al
Cardiac CT for acute epigastric pain
143 his jaw. The pain was partially relieved with nitroglycerine and aspirin. Blood pressure was similar in both upper extremities. The electrocardiograms were normal, and cardiac enzymes were mildly elevated. Portable chest x-ray showed an enlarged cardiac silhouette and a tortuous and elongated aorta. A 64-row prospectively triggered coronary CT angiography (CTA) showed a type A aortic dissection with a small tear in the mid ascending aorta and extravasation of the contrast into the mediastinum and pericardium. An unusual finding included the presence of a moderate amount of hematoma surrounding coronary arteries at the right atrioventricular groove (Fig. 1 and Fig. 2). Coronary CTA showed mild nonobstructive coronary artery disease. The patient survived after successful emergency repair of the ruptured type A aortic dissection (Fig. 3). This case highlights the application of 64-slice multidetector CT technology in patients presenting with acute chest pain with simultaneously assessment of the aorta and coronary arteries with high accuracy and provides an example of using this technique not only for the diagnostic purpose but also for thorough anatomic analysis before any possible cardiothoracic intervention.1,2
References
Figure 3 Intraoperative pictures show the clot covering the rupture (white arrow) in the mid ascending aorta (A), confirming the findings of cardiac CT and the dissected intimal flap (B).
1. Hoffmann U, Ferencik M, Cury RC, Pena AJ: Coronary CT angiography. J Nucl Med. 2006;47:797–806. 2. Cury RC, Feutchner G, Pena CS, Janowitz WR, Katzen BT, Ziffer JA: Acute chest pain imaging in the emergency department with cardiac computed tomography angiography. J Nucl Cardiol. 2008;15:564–75.