Problems in the Aortographic Diagnosis of Dissecting Aneurysm of the Aorta

Abstract

In 44 patients with suspected dissecting aneurysm of the aorta, an aortographic diagnosis of dissection, based on the demonstration of a narrowed true lumen and of a false channel, was made in 23. Aortographic findings were negative for dissection in 11. In the remaining 10 diagnostic difficulties were encountered. In four, eventually shown to have dissection, problems resulted from faint false-channel opacification, unusual tearing of the intima and equal simultaneous opacification of both channels. In one with aortic insufficiency, findings suggestive of false-channel injection were caused by layering of contrast material in the descending aorta. In another, mediastinal rupture of a thoracoabdominal aneurysm simulated thickening of the aortic wall. In the remaining four, a definite diagnosis could not be made. Three of these had thickening of the aortic wall as the only abnormality, and one had a hemothorax obscuring the descending aortic wall.