Root-localized aortic dissection in Loeys–Dietz syndrome diagnosed with the coronary computed tomography angiography: a case report

Background: Aortic dissection is caused by a tear in the inner layer of the aorta, and blood comes between the layers of the aortic wall. Contrast-enhanced computed tomography (CT) is typically considered to be useful in its diagnosis. However, in cases of aortic dissection localized to the aortic root, diagnosis with CT or echocardiography can be challenging. Case Summary: We report the case of a patient with root-localized aortic dissection that presented with acute aortic valve regurgitation. Contrast-enhanced chest CT revealed marked dilation of the aortic root, but it did not show evidence of dissection. However, there was a marked dilation of the aortic root and acute aortic regurgitation, which suggested root-localized dissection. Conventional CT was limited by motion artefacts and did not demonstrate dissection, so we decided to perform cardiac-gated CT to achieve a more accurate evaluation of the aortic root. This allowed us to make a definite diagnosis and proceed to life-saving surgery. Discussion: Acute type A-localized aortic dissection has several clinical features that were distinct from acute type A aortic dissection, which we summarize with prior cases. We found cardiac-gated CT to be useful in making definite diagnosis in this case.