{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:31:30Z","timestamp":1786354290694,"version":"build-2736575974"},"reference-count":11,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength\u2014such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols.<\/jats:p>","DOI":"10.3390\/reports9030262","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:53Z","timestamp":1786349333000},"page":"262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aortic Dissection Mimicry Under Extracorporeal Membrane Oxygenation (ECMO) After Cardiac Arrest: A Case Report of Emergency Imaging Dilemmas"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4090-0691","authenticated-orcid":false,"given":"Yueh-Cheng","family":"Tu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8773-1847","authenticated-orcid":false,"given":"Meng-Yu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giou-Teng","family":"Yiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1004-312X","authenticated-orcid":false,"given":"Yu-Long","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/icvts\/ivv366","article-title":"Contrast layering artefact mimicking aortic dissection in a patient on veno-arterial extracorporeal membrane oxygenation undergoing computed tomography scan","volume":"22","author":"Goslar","year":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1148\/rg.210079","article-title":"CT Angiography of Venoarterial Extracorporeal Membrane Oxygenation","volume":"42","author":"Shen","year":"2022","journal-title":"Radiographics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00392-015-0941-1","article-title":"Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults","volume":"105","author":"Napp","year":"2016","journal-title":"Clin. Res. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e182","DOI":"10.1097\/MAT.0000000000002220","article-title":"A Guide to Contrast-Enhanced Computed Tomography in Adult Patients Supported With Extracorporeal Membrane Oxygenation","volume":"70","author":"Diehl","year":"2024","journal-title":"Asaio J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"72","DOI":"10.12945\/j.aorta.2016.15.021","article-title":"Computed Tomography Imaging Artifact Simulating Type A Aortic Dissection","volume":"4","author":"Chou","year":"2016","journal-title":"Aorta"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00059-006-2791-0","article-title":"Echocardiographic findings mimicking type A aortic dissection","volume":"31","author":"Alter","year":"2006","journal-title":"Herz"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1214.e5","DOI":"10.1016\/j.ajem.2019.02.039","article-title":"Transesophageal echocardiography identification of aortic dissection during cardiac arrest and cessation of ECMO initiation","volume":"37","author":"Kelly","year":"2019","journal-title":"Am. 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Emerg. Crit. Care Med."},{"key":"ref_11","first-page":"252","article-title":"Answer: Diagnostic dilemma in a critical extracorporeal membrane oxygenation patient: A case of uncertain aortic pathology","volume":"14","author":"Duarte","year":"2025","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/262\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:52:06Z","timestamp":1786351926000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030262"],"URL":"https:\/\/doi.org\/10.3390\/reports9030262","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}