Presentation
Known hypertensive presents with bradycardia
Patient Data
An extensive dissection is noted from the aortic valve root, ascending aorta, aortic arch and descending aorta, all the way to the infra-renal aorta. The dissection extends to the left common carotid artery and partially into the superior mesenteric artery origin. The smaller true lumen is on the medial aspect of the aorta, and is compressed by the larger outer false lumen which is present on the left posterolateral aspect of the descending aorta and right anterolateral aspect of the descending aorta. In the distal aorta, some coarse atherosclerotic calcification is noted.
A large intramural thrombus is seen surrounding the left common iliac artery all the way to its bifurcation. There is a large filling defect in the right internal jugular vein consistent with a thrombus.
Multiple collateral vessels are noted in the right upper chest wall. A right subclavian central venous catheter is in situ with its tip in the SVC.
The celiac axis, renal arteries and inferior mesenteric arteries are well opacified with contrast and no extension of the dissection into them is noted.
The thyroid gland is enlarged with multiple tiny hypodense cysts and some coarse calcifications. There is retro tracheal extension of both lobes causing mild tracheal narrowing. Bilateral pleural effusions are present with atelectasis of the adjacent poster basal lungs
The liver, biliary ducts, gall bladder, pancreas, spleen, adrenals and kidneys are within normal limits. The stomach is tiny and post-surgical clips are noted around it. The small and large bowel loops do not show any abnormality. No lymph node enlargement or free fluid is seen in the abdomen or pelvis. The urinary bladder and pelvic viscera are normal.
Mild degenerative changes are present in the visualized on the spine.
Case Discussion
This is a type of aortic dissection Stanford type A , DeBakey type I.
Aortic dissection is an intimal tear that allows blood to seep into and split the aortic wall creating a second, false lumen. Risk factors include hypertension which is the most common cause, bicuspid aortic valve, connective tissue diseases like Marfan syndrome and the use of amphetamines and cocaine. An aortic dissection occurs due to the increased shearing forces against the intimal wall.
Aortic dissection is a life-threatening emergency with a high mortality rate.