Aortic dissection: Stanford type A

Case contributed by Dr Dylan Kurda

Presentation

Sudden severe "tearing" chest pain.

Patient Data

Age: 45-50 years
Gender: Female

There is a dissection flap which has involved the aortic root, extending to the arch as well as reaching to the abdominal aorta, below its bifurcation, consistent with Stanford A aortic dissection. 

It is difficult to properly assess the coronary arteries as the images are not gated.

The flap extends to the aortic arch, which appears to have also involved brachiocephalic truck as well as left common carotid artery (images more cranial not shown). While the left subclavian artery appears to have been taken off from the true lumen of the aortic arch. 

There is a large wedge shaped hypoattenuated area in the left kidney, consistent with renal infarction probably as a result of flap extending to the left renal artery. 

The right renal artery appears to be originating from the true lumen, with a normally enhancing right kidney. 

The true lumen also gives rise to the celiac axis, superior mesenteric as well as inferior mesenteric arteries. The celiac axis anatomy is conventional. 

The dissection flap extends below the aortic bifurcation and involves the proximal parts of external as well as internal iliac arteries on the right side. On the left side, the flap is similarly involving the left common iliac artery (which becomes nearly totally unopacified distally), with only trace of contrast seen in the proximal few centimetres of left external as well as internal iliac arteries (the contrast opacification reconstitues afterwards). 

No pericardiac or pleural collection identified. 

No bowel wall thickening/retroperitoneal hematoma. 

Large left renal cyst. 

Case Discussion

Findings are consistent with Stanford type A (DeBakey type I) aortic dissection.

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Case information

rID: 39094
Case created: 19th Aug 2015
Last edited: 2nd Oct 2015
System: Vascular
Inclusion in quiz mode: Included

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