Presentation
Collapse. Hypotension.
Patient Data
Rotated film with excluded left costophrenic angle. There is marked superior mediastinal widening with a lobulated, rounded contour to the aortic arch region. A massive left pleural effusion, likely hemothorax, is present, causing left hemithorax whiteout and mild rightward mediastinal shift.
Aortic dissection arising in the proximal descending thoracic aorta, approximately 2 cm distal to the origin of the subclavian artery, extends for the entire extent of the descending thoracic and abdominal aorta to the level of the aortic bifurcation.The intimal tear in the proximal descending aorta creates a passage to the false lumen that opacifies with contrast.
The descending thoracic and abdominal aorta is tortuous and aneurysmal. The false lumen terminates just lateral to the origin of the left common iliac artery. Mural thrombus is demonstrated in the descending thoracic and abdominal aorta.
Conclusion:
- extensive type B aortic dissection, as described above
- large left hemothorax and mediastinal hematoma are suggestive of rupture of the dissected aneurysmal descending thoracic aorta
- left renal artery appears to arise from the false lumen of the abdominal aorta
- left renal hypoperfusion is suspected
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