Presentation
Chest pain
Patient Data
Circumferential hyperdense ring in the ascending aorta (73 HU) causing luminal narrowing representing acute intramural hematoma. It is non enhancing in the post contrast images.
Dissection flap at the ascending aorta distal to the intra mural hematoma running down to the descending thoracic aorta, abdominal aorta, down to the proximal parts of left common iliac artery.
Superiorly, dissection flap is running to the proximal part of brachiocephalic trunk.
True and false lumens present at mentioned levels.
Aneurysmal dilatation of false lumen in aortic arch and descending aorta.
False lumen is large and hypodense compared to true lumen from the aortic arch down to the renal arterial levels.
Left renal artery originating from well enhancing false lumen.
Right renal artery originating from well enhancing true lumen.
Normal parenchymal enhancement of both kidneys.
No aortic rupture.
Case Discussion
Acute Intramural hematoma in the ascending aorta with resultant luminal narrowing.
Aortic dissection, Stanford type A
This case is contributed by Dr. Naqibullah Foladi and Dr. M.M.S. Hoshang