J Korean Soc Radiol.  2017 Dec;77(6):367-371. 10.3348/jksr.2017.77.6.367.

Evaluation of Localized Aortic Dissection at Sinus of Valsalva by Coronary CT Angiography with Multiplanar Reformation: A Case Report

• Lee KW
• Kim DH
• Yoon EJ
• Seo HJ
• Ryu SW
• Choi DH

• KMID: 2396494
• DOI: http://doi.org/10.3348/jksr.2017.77.6.367

Abstract

Localized aortic dissection at the sinus of Valsalva is a rare finding in patients with Stanford type A dissections. This condition can be fatal and difficult to diagnose. In this study, we report a case of a 69-year-old man with aortic dissection at the sinus of Valsalva, which was accurately diagnosed with multiplanar reformatted images of coronary computed tomography angiography, and later confirmed at surgery.

MeSH Terms

Aged
Angiography*
Aorta
Humans
Multidetector Computed Tomography
Sinus of Valsalva*

Figure

• 

  Fig. 1 Localized aortic dissection at the sinus of Valsalva with vegetations and dystrophic calcification in a 69-year-old man. A. Chest radiograph shows cardiomegaly, pulmonary congestion, and bilateral pleural effusion. B. Short axis view of initial CCTA represents dilated AA without evidence of dissection. There is a small contrast filled outpouching which communicates with the non-coronary Valsalva sinus (arrow). C. Trans-esophageal echocardiogram demonstrates dilatation of AA and vegetations of aortic valve (arrows). D. Coronal oblique MPR image in the follow-up CCTA (right panel) shows the dissection flap involving the non-coronary sinus of Valsalva (arrowheads). Ascending thoracic aorta is dilated. Solid and empty arrows indicate right coronary artery and left main coronary artery, respectively. Another coronal oblique MPR image (left panel), obtained posteriorly to the right panel, demonstrates localized aortic dissection at the sinus of Valsalva (arrowheads). E. Axial oblique MPR image in the follow up CCTA, which is reconstructed to correspond with the intra-operative picture (F), presents a dissection flap (arrowheads) that starts from the N and extends to the L. F. Intra-operative picture shows the extensive dissection flap (arrowheads), extending from the N to the L.. AA = ascending thoracic aorta, CCTA = coronary computed tomography angiography, L = left coronary sinus, LCX = left circumflex coronary artery, MPR = multiplanar reformatted, N = non-coronary sinus, R = right coronary sinus

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