Type A Aortic Dissection Mimicking a Saddle Pulmonary Embolus on Computed Tomographic Angiography
A 21-year-old man presented with acute onset of severe, ripping chest pain. He reported mild dyspnea but denied other associated symptoms, including leg swelling, palpitations, or neurological symptoms. He had a long-standing personal history of hypertension and reported a family history of venous thromboembolism and diabetes mellitus.
On physical examination, the patient was tachycardic and hypertensive (systolic blood pressure in the range of 160–170 mm Hg). Computed tomographic angiography of the chest was performed. Computed tomographic angiography revealed an aneurysm of the ascending aorta measuring up to 6 cm in diameter with a focal outpouching posteriorly just superior to the takeoff of the left main coronary artery and a high-attenuation pericardial effusion, findings concerning for focal type A aortic dissection with contained rupture …