Thoracic-Abdominal Aortic Aneurysm With Coexisting Acute and Chronic Aortic Dissection on FDG PET/CT

Aortic dissection is evaluated by CT angiography (CTA). FDG can highlight the active inflammation, which can help differentiate acute from chronic wall disease. A 58-year-old man with multiple comorbidities developed acute epigastric pain and hemoptysis. He was referred for management of ~5.8 cm thoraco-abdominal aortic aneurysm (TAAA) detected on CTA. 18 F-FDG PET/CT was ordered and revealed intensely avid intramural hematoma along the wall of the proximal descending thoracic aorta, reflecting acute dissection coexisting with distal, less hypermetabolic chronic intramural hematoma.