Presentation
67 year-old male prsenting with sudden onset central chest pain, with radiation superiorly into his neck. Associated with hypotension and tachycardia.
Patient Data
AORTA AND BRANCHES: An aortic dissection extending from the sinotubular junction to the distal abdominal aorta, 1.1 cm cranial to the aortic bifurcation into common iliac arteries. The false lumen is seen to originate at the rightward aspect of the sinotubular junction, not involving the coronary arteries or aortic sinus. The false lumen courses on the posterior rightward aspect of the aortic arch and anterior leftward aspect of the descending thoracic aorta. An intimal flap with a 13mm defect is noted in the anterior leftward aspect of the true lumen of the ascending aorta. The major aortic arch branches are not involved and opacify normally. Within the thoracic aorta, the false lumen is located on the right.
The celiac trunk, superior inferior mesenteric arteries enhance normally. Two right renal arteries noted (a superior large caliber and a smaller caliber inferior artery) which opacify normally. A single left renal artery opacifies normally. The dissection does not extend into the common iliac arteries. The common iliac opacified normally.
CHEST: No consolidation, pneumothorax, pleural or pericardial effusions.
ABDOMEN AND PELVIS: The liver, gallbladder, spleen, pancreas, adrenals, kidneys and bowel are unremarkable.
SKELETAL: No focal destructive osseous lesions.
CONCLUSION: Stanford Class A and DeBakey type 1 aortic dissection from the sinotubular junction to the terminal aortic bifurcation, the major branches of the aorta are opacified normally and the coronary arteries and sinus are not involved.
Case Discussion
This case illustrates a Stanford Class A and De Bakey type 1 acute aortic dissection.
An aortic dissection refers to the tear of the tunica intima and media in the wall of the aorta with resulting ingress of blood, forming a false lumen, with variable proximal and/or distal extension1,2. The dissection is termed2,3:
- Acute if the diagnosis is made within 14 days following the initial onset of symptoms
- Chronic if present for more that two weeks
There are two classification systems used for the staging of an aortic dissection2,4:
1. Stanford Classification
- The Stanford classification of aortic dissection distinguishes between type A and type B, depending on whether the ascending aorta is involved
- Type A: The dissection involves the ascending aorta
- Type B: The dissection involves the descending aorta only
2. De Bakey Classification
- The De Bakey classification categorizes the dissection based on where the original intimal tear is located and the extent of the dissection
- Type I: The dissection involves ascending aorta, aortic arch, and descending aorta.
- Type II: The dissection is confined to ascending aorta only
- Type III: The dissection is confined to descending aorta distal to the left subclavian artery only.
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