The role of intravascular ultrasound scan and thin-sliced coronary computed tomography angiography in diagnosing aortic dissection causing acute myocardial infarction

Introduction: Acute aortic dissection is a disease of high mortality. The symptoms may mimic other conditions and misdiagnosed, such as acute coronary syndrome, coronary involvement complicates the clinical scenario and increases mortality. Case Report: We herein report a case of an acute myocardial infarction caused by acute aortic dissection. Without noticing the aortic dissection, we performed emergent coronary angiography, which showed severe stenosis of the proximal right coronary artery. Intravascular ultrasound scan led us to suspect aortic dissection. However, we performed balloon angioplasty because the patient's hemodynamic status was unstable. ECG-gated coronary computed tomography angiography provided a definitive diagnosis, and the patient underwent successful surgical repair of the aortic dissection. Conclusion: Acute coronary syndrome associated with acute aortic dissection is not rare. However, the management of these conditions depends on the details of each case. This case demonstrates the difficulty of treating such cases in the real world. Herein, we describe educational imaging findings and briefly discuss the management of cases involving acute coronary syndrome associated with acute aortic dissection.