Aortic dissection

Case contributed by Dr Ahmed Elowaidy

Presentation

Patient presented with sudden severe chest and abdominal pain, absent pulse in left arm.

Patient Data

Age: 69
Gender: Male
CT

Chest , abdomen and pelvis

Extensive aortic dissection, seen involving ascending aorta, aortic arch, descending and abdominal aorta and seen extending into left common iliac artery, left subclavian, proximal aspect of SMA, left renal artery and right innominate arteries 

There is non enhancement of the Rt CCA, with thrombus formation and very faint peripheral flow.

No evidence of active leaking or retro peritoneal or mediastinal haematoma.

There is attenuation of the common hepatic artery, however there is flow within the distal branches

Severe decreased enhancement of the left kidney, keeping with significant ischemic changes /infarction

Distal aspect of SMA, IMA and right renal are enhancing

Multiple small bowel loops are of increased mucosal enhancement while others show severely decreased mucosal enhancement, suggesting  ischemic bowel changes, no pneumatosis, no free abdominal air, no portal or SMV venous gas

Thrombosed  midaspect of the splenic artery, its distal aspect showing filling from collaterals, suggesting this one was not acute and it was there for some time

Thrombosed right CIA, Rt EIA, with bifemoro arterial graft anastomosis, the Rt CFA is seen filled from the graft

Diagnosis: 
Severe aortic dissection, Debakey  I, Stanford A, complicated by intestinal ischemia and severe left renal ischemia/infarction and thrombosis of right common carotid artery

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Case information

rID: 24884
Case created: 17th Sep 2013
Last edited: 10th Sep 2015
System: Vascular
Inclusion in quiz mode: Included

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