History: 60 year old male presents with acute abdominal pain to an outside hospital. Abnormal unexpected finding on an abdominal CT at the outside hospital (not available) prompted immediate transfer to your university hospital. CT Chest ordered.
© 2012 Must See Radiology
Axial and Coronal contrast enhanced CT images of the chest at the level of the ascending aorta and aortic arch.
Axial contrast enhanced CT image of the chest at the level of the coronary arteries (red arrows) demonstrates a dissection flap (yellow arrow) with a true lumen (T) and false lumen (F). Since the aortic dissection begins before the left subclavian artery, it is considered a Stanford Type A.
Coronal contrast enhanced CT image of the chest at the level of the aortic arch demonstrates a dissection flap with a true lumen ( T and red highlight) and a false lumen (F). Note the false lumen extending into the brachiocephalic artery. View the next key finding.
Axial contrast enhanced CT image of the chest at the level of the carotid bulbs. There is near total occlusion of the right common carotid artery (yellow arrow) secondary to the dissection flap. Compare the abnormal right common carotid artery (yellow circle) with the normal left side (white circle). This finding demonstrates a reason why Stanford A type of aortic dissections are surgical emergencies. If the dissection begins distal to the takeoff of the left subclavian artery, it is considered a type B and can be treated more conservatively.
© 2012 Must See Radiology
Aortic Dissection
Stanford A
This patient presented to an outside hospital with vague abdominal pains. A contrast enhanced CT demonstrated an aortic dissection with the flap involving a portion of the proximal SMA. The scan included a large portion of the chest and it was suggested by the radiologist that the dissection appeared to be involving the aortic root, although not well visualized. The patient was transferred to our hospital for emergency vascular surgery. After speaking with the surgeon regarding the case, he revealed the patient's sister had Marfan's disease, a condition associated with a higher risk for aortic dissection.
Additional Information:
Fisher, ER "Acute Aortic Dissection: Typical and Atypical Imaging Features" Radiographics 1994: 14, 1263-1271.
McMahon, MA "Multidetector CT of Aortic Dissection: A Pictorial Review" Radiographics 2010: 30, 445-460.
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© 2012 Must See Radiology