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Aortic dissection - Stanford type A

Case contributed by: Dr Saeed Soltany Hosn

Presentation:

A 65-year-old male with a history of untreated hypertension was admitted to the emergency room with acute severe chest pain. CT scan was performed with a provisional diagnosis of aortic dissection.

Patient Data:

Age: 67-year
Gender: Male
Race: Caucasian
Modality: CT

Contrast enhanced MDCT shows a dissection flap involving the asending aorta,aortic root and descending aorta. The dissection involve the aortic root and extends distally through the aortic arch and into the abdominal aorta.

The true lumen is compressed anterolaterally by the larger false lumen and the entry point of the dissection is clearly delineated in the axial and coronal plane (thin arrow) . There is no evidence of heamopericardium. Note the extension of the dissection flap into the brachiocephalic trunk. There is medial displacement of the abdominal aortic wall calcification. There is also evidence of the extension of the septum into the ostium of the superior mesenteric artery  ; and a wedge-shaped, low-attenuation paranchymal lesion in the lower pole of the right kidney,in favour of focal renal infarction. In addition there is transient high attenuation of the left hepatic lobe (open arrow) due to filling of the coeliac trunk from both the true and false lumens as well.

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