Aortic dissection

Case contributed by Naim Qaqish


This patient with poor control of high blood pressure, known to have aortic dissection to evaluate extension of the disease.

Patient Data

Age: 60 years
Gender: Male

There is evidence of a type B aortic dissection with intimal flap starting at the aortic arch extending to involve the junction with the descending aorta, and the descending aorta downward to reach the bifurcation and beyond that to the right common iliac artery without significant aneurysmal dilatation.

The celiac trunk, superior mesenteric, and both renal arteries are seen arising from the true lumen and not involved.

Both false and true lumens appear to have a flow in them, but with less flow in the false lumen.

There are no signs of leakage.

Case Discussion

This is a 60-year-old man presented to the cardiovascular clinic, with poorly controlled hypertension. Diagnosed at other institution to have an aortic dissection. CTA was requested to evaluate the extent of his disease, demonstrating Stanford type B aortic dissection. However, a new classification system was proposed which is referred with the acronym DISSECT was also looked at during our discussion with the interventional cardiology team.

It is extremely important to identify the true lumen in cases of aortic dissection, as placement of an endoluminal stent-graft in the false lumen can have serious consequences.

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