Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography

Poonam Batra*, Brian Bigoni, John Manning, Denise R. Aberle, Kathleen Brown, Eric Hart, Jonathan Goldin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

146 Scopus citations


Two hundred seventy-five computed tomographic (CT) angiograms of the thoracic aorta were obtained over a period of approximately 4 years in patients with suspected or known aortic dissection. In all cases, unenhanced images were initially obtained, followed by contrast material-enhanced images. A variety of pitfalls were encountered that mimicked aortic dissection. These pitfalls were attributable to technical factors (eg, improper timing of contrast material administration relative to image acquisition); streak artifacts generated by high-attenuation material, high-contrast interfaces, or cardiac motion; periaortic structures (eg, aortic arch branches, mediastinal veins, pericardial recess, thymus, atelectasis, pleural thickening or effusion adjacent to the aorta); aortic wall motion and normal aortic sinuses; aortic variations such as congenital ductus diverticulum and acquired aortic aneurysm with thrombus; and penetrating atherosclerotic ulcer. Although several of these pitfalls are easy to recognize and therefore unlikely to present a diagnostic problem, others are potentially confusing. Familiarity with these common pitfalls, coupled with a knowledge of normal intrathoracic anatomy, will facilitate recognition of true aortic dissection and help avoid misdiagnosis at thoracic aortic CT angiography.

Original languageEnglish (US)
Pages (from-to)309-320
Number of pages12
Issue number2
StatePublished - Jan 1 2000


  • Aorta, CT, 94.12916, 94.74
  • Aorta, dissection, 94.74, 94.93
  • Aortography, 94.121

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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