Atypical dissection of the thoracic aorta
Elderly lady who became victim of a high impact trauma, unexplained hemoglobin loss on 3d day after admission.
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The intimal defect is located just distal of the left subclavian artery, which is typical for a traumatic rupture. On this level the patient also has vertebral fractures and a shoulder fracture.
The wall of the descending aorta is thickened and shows mild concentric enhancement, the intima is displaced medially (calcifications). This means that there is a tear or hematoma in the media. Since there is no typical "flap" as seen with most type B dissections, it is considered as an "atypical aortic dissection" with intramural hematoma.