case_images: PMC10653977_01
case_images: Initial chest CT, coronal view demonstrates what was believed to be a dissection flap (arrow) extending superiorly from the level of the anterior cusp of the aorta.
case_images: CRIC2023-1385305.001.jpg
case_images: PMC10653977_01_CRIC2023-1385305.001.jpg
case_images: fig1
case_images: The CT was also concerning for a dissection flap extending from the level of the anterior aortic cusp distally for 2.7 cm (Figure 1).
case_images: 2D TTE, suprasternal view demonstrates a dilated ascending aorta (Ao) and what was thought to be an intimal dissection flap (white arrows). RPA: right pulmonary artery.
case_images: CRIC2023-1385305.002.jpg
case_images: PMC10653977_01_CRIC2023-1385305.002.jpg
case_images: fig2
case_images: A repeat TTE (Figure 2) was obtained which again demonstrated what was interpreted as an intimal flap suggestive of an ascending aortic dissection.
case_images: Repeat chest CT, coronal (a) and axial (b) views demonstrate a dilated ascending aorta (21.8 mm; Boston Z-score 2.84) and a suspected intimal dissection flap extending anteriorly off of the anterior cusp (thin arrow) just above the sinotubular junction. For comparison, the normal anatomic location for the RAA is highlighted (open arrow).
case_images: CRIC2023-1385305.003.jpg
case_images: PMC10653977_01_CRIC2023-1385305.003.jpg
case_images: fig3
case_images: A repeat CT was interpreted as showing an ascending aortic aneurysm extending anteriorly from the anterior cusp starting just above the sinotubular junction and extending obliquely along the left side of the ascending aorta and just proximal to the transverse arch (Figures 3(a) and 3(b)).
case_images: Noncontrast CMR obtained in axial (a-c), sagittal (d), and coronal views (e). Sequential imaging obtained in 3D Heart Navigator Sequence during systole of the aortic root was performed moving from more cephalad to more caudad. The aortic root is intact, and there is no evidence of aneurysm as suspected on CCT. Instead, the arrows in each image highlight the unusual course of the RAA anteriorly around the root of the aorta extending to the left side and account for the suspected intimal flap previously noted.
case_images: CRIC2023-1385305.004.jpg
case_images: PMC10653977_01_CRIC2023-1385305.004.jpg
case_images: fig4
case_images: Cardiovascular magnetic resonance (CMR) was obtained (Figures 4(a)-4(c)) which demonstrated that what was initially thought to be a dissection was in fact the LJRAA.