Acute Limited Intimal Tear of the Right Aortic Sinus.

Abstract

HomeRadiology: Cardiothoracic ImagingVol. 3, No. 6 Previous Images in Cardiothoracic ImagingFree AccessVascular ImagingAcute Limited Intimal Tear of the Right Aortic SinusLucas de Pádua Gomes de Farias , Márcio Campos Sampaio, José Honório de Almeida Palma da Fonseca, Luciana de Pádua Silva BaptistaLucas de Pádua Gomes de Farias , Márcio Campos Sampaio, José Honório de Almeida Palma da Fonseca, Luciana de Pádua Silva BaptistaAuthor AffiliationsFrom the UnitedHealth Group Brazil, Hospital Samaritano Paulista, Avenida Brigadeiro Luís Antônio 1895, Bela Vista, São Paulo, SP 01317-002, Brazil.Address correspondence to L.d.P.G.d.F. (e-mail: [email protected]).Lucas de Pádua Gomes de Farias Márcio Campos SampaioJosé Honório de Almeida Palma da FonsecaLuciana de Pádua Silva BaptistaPublished Online:Dec 2 2021https://doi.org/10.1148/ryct.210239MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Limited intimal tears (LITs) are uncommon but potentially lethal lesions within the dissection spectrum, occurring in approximately 5% of patients presenting with acute aortic syndrome (1). LITs are classified as a “class 3 of intimal tear” and represented by intimomedial tears with an eccentric aortic wall bulge but without substantial hematoma (2). While the edges of an LIT can be undermined to a variable degree and filled with small amounts of blood or clot, there is no propagation of the dissection plane along the aorta and no exit tear and double-barrel flow channel as in classic aortic dissection (1,3). LITs may evade identification at transesophageal echocardiography or CT because of the limited extent of undermined intimal layers and a minimal amount of blood in the dissected aortic wall. This imaging pitfall can result in progression of dissection, cardiac tamponade, or aortic rupture causing potentially lethal outcomes (1,2,4). Furthermore, the diagnosis of LITs may be missed if conventional diagnostic criteria that are dependent on the presence of an intimal flap are applied (4). Awareness of this entity, high index of suspicion at CT angiography with use of appropriate reconstruction techniques for the aortic root may allow timely patient management (1) (Figure).Images in a 62-year-old man who presented to the emergency department with acute chest pain. (A) Short-axis view of the aortic root, (B) three-chamber view, (C–E) three-dimensional volume-rendered images, and (F) intraoperative view after median sternotomy with extracorporeal circulation show an eccentric bulge of the right aortic sinus (R) with the presence of a focal limited tear (arrowhead). This is represented by focal linear “flaps” with undermined edges, as a bandlike outpouching where the right coronary artery (RCA) took off. The patient underwent graft replacement of the ascending aorta and aortic valve replacement. AA = ascending aorta, LA = left atrium, LV = left ventricle, LM = left main artery, R/L/NC = right/left/noncoronary aortic sinus.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: L.d.P.G.d.F. No relevant relationships. M.C.S. No relevant relationships. J.H.d.A.P.d.F. No relevant relationships. L.d.P.S.B. No relevant relationships.Keywords: CT Angiography, Vascular, Aortic RootAuthors declared no funding for this work.