Aortic ductus diverticulum mimicking aortic dissection: a case of diagnostic ambiguity in transthoracic echocardiography
  • Hazem Taifour
    Rochester Regional Health/Unity Hospital, Rochester, USA
  • Fahad Eid
    Rochester Regional Health/Unity Hospital, Rochester, USA
  • Mohamed Abu Sheikha
    Rochester Regional Health/Unity Hospital, Rochester, USA
  • Ryan Hoefen
    Rochester Regional Health/Unity Hospital, Rochester, USA

Keywords

Aortic ductus diverticulum, cardiac imaging, aortic dissection

Abstract

Background: Aortic dissection is a critical condition often presenting with acute, severe chest pain and haemodynamic instability. Early diagnosis is essential to mitigate the high mortality risk. Imaging modalities play a pivotal role in diagnosing aortic conditions, but determining the appropriate method can be challenging.
Case description: We report an asymptomatic 55-year-old female undergoing transthoracic echocardiography (TTE) for mitral and aortic valve regurgitation surveillance. Incidentally, a suspicious flow jet at the distal aortic arch was discovered, raising concerns of aortic dissection. A subsequent CT angiogram (CTA) identified this as an aortic ductus diverticulum at the aortic isthmus, not a dissection.
Discussion: Aortic dissection has a high initial 48-hour mortality, with even surgically managed cases exhibiting a 26% risk. Imaging tools such as a transoesophageal echocardiogram (TEE), CT and MRI scans are instrumental for diagnosis, with their applicability depending on the patient’s clinical situation. The aortic ductus diverticulum, a developmental outpouching, often mimics other aortic pathologies, emphasising the importance of accurate imaging interpretation.
Conclusion: Aortic ductus diverticulum presents diagnostic challenges due to its resemblance to other aortic conditions. Advancements in imaging modalities improve diagnostic accuracy, but awareness and careful interpretation are paramount to ensure timely and appropriate patient care.

VIEW THE ENTIRE ARTICLE

References

  • Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 2006;166:1350–1356.
  • Gaillard F, Baba Y, Weerakkody Y, et al. Ductus diverticulum. Radiopaedia.org [Internet]. Radiopaedia; [cited 2023 Jan 12]. Available from: https://radiopaedia.org/articles/ductus-diverticulum. doi: 10.53347/rID-1239
  • Goodman PC, Jeffrey RB, Minagi H, Federle MP, Thomas AN. Angiographic evaluation of the ductus diverticulum. Cardiovasc Intervent Radiol 1982;5:1–4.
  • Myojin K, Ishibashi Y, Ishii K, Itoh M, Watanabe T, Kunishige H. Aneurysm of the nonpatent ductus arteriosus in the adult--a report of the case and review of the literature. Jpn J Thorac Cardiovasc Surg 1998;46:882–888.
  • Shichijo T, Suehiro K, Sakakibara H, Okada M, Yoshida H, Ohba O. A case report of aneurysm of the diverticulum of the ductus arteriosus in the elderly. Kyobu Geka 1994;47:299–301.
  • Wimpfheimer O, Haramati LB, Haramati N. Calcification of the ligamentum arteriosum in adults: CT features. J Comput Assist Tomogr 1996;20:34–37.
  • Sugimoto T, Takahashi T, Inui K, Minowa T, Watanabe T, Shimazaki Y. Aneurysm of the ductus diverticulum in adults: the diagnostic value of three-dimensional computed tomographic scanning. Jpn J Thorac Cardiovasc Surg 2003;51:524–527.
  • Forbes J, Yong-Hing CJ, Galea-Soler S, Nicolaou S. Ductus diverticulum: a confusing normal variant in the setting of trauma. Eur J Radiol 2010;75:e59-e61.

    • Views: 215
    HTML downloads: 40
    PDF downloads: 192

    Published: 2023-11-29
    Issue: 2024: Vol 11 No 1 (view)

    How to cite:
    1.
    Taifour H, Eid F, Abu Sheikha M, Hoefen R. Aortic ductus diverticulum mimicking aortic dissection: a case of diagnostic ambiguity in transthoracic echocardiography. EJCRIM 2023;11 doi:10.12890/2023_004183.