Extract

We report the case of a 84-year-old patient, with a history of coronary artery bypass graft (CABG) and mitral valve replacement 11 years ago and a recent access to an emergency department for acute chest pain. The patient was quickly discharged because of negative troponin without any radiological examination.

Six days later, the patient referred to our emergency department for chest pain and dyspnoea. Owing to an elevated D-dimer, patient underwent chest computed tomography (CT) for suspected pulmonary embolism (PE).

CT pulmonary angiography did not show PE but a significant pulmonary artery compression (Panels A and B). A subsequent arterial phase demonstrated a Type A aortic dissection originating from the sinotubular junction and a 2-mm wall rupture with huge mediastinal haematoma (diameters 5.7 × 12.3 cm), causing significant compression of pulmonary artery trunk, left atrium and superior left pulmonary vein (Panel C).

Owing to the very high risk of mortality, the surgical intervention was refused by the patient's relatives and an appropriate anti-hypertensive therapy was administered.

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