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A 22 year old man was found to have a 5.4 cm aortic root aneurysm upon screening echocardiogram. He had no Marfanoid features. His 19 year old brother had died suddenly of an acute ascending aortic dissection six weeks previously. A cardiology appointment was scheduled, but in the interim he developed transient chest, neck, and jaw burning. He was transferred pain-free from his local emergency room for further evaluation.
A computed tomographic (CT) scan with contrast showed an enlarged ascending aorta. A second CT and a two dimensional echocardiogram were performed within seven hours and was unchanged. Though no dissection was seen, he was recommended to have surgery. Cardiac magnetic resonance imaging (MRI) was performed before the surgery. At surgery, a subacute, nearly circumferential intimal and medial tear of the ascending aorta was found above the aortic valve. There was no dissection in either the antegrade or retrograde direction. The pericardial space contained no free blood. The patient received a 25 mm St Jude composite graft with coronary artery reimplantation, and he recovered uneventfully.
In this case cardiac MRI enabled an early intimal tear to be visualised before the better known features of dissection became present.
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