Thoracic aortic dissection - stanford type B

Presentation

Stab wound to left chest

Patient Data

Age: 43
Gender: Male

There is no pneumothorax or hemothorax and both lungs are clear. There is marked widening of the mediastinum, most of this is a rather prominent aortic arch and descending thoracic aorta. However, the right paratracheal region is also widened. This is a well centered chest x-ray and the possibility of a mediastinal vascular injury needs to be entertained.

Thoracic angiogram

CT

Aortic dissection with intimal flap noted in the thoracic aorta commencing just distal to the subclavian artery branch point extending down to the T10 level. The maximum transverse diameter measures 57 mm just distal to the subclavian artery branch point. No evidence of atherosclerosis. No mediastinal hematoma or pericardial effusion seen. Mild cardiomegaly. Biapical blebs. No pneumothorax identified.  Lingular bibasal atelectasis. No pleural effusion seen. No abnormality in the anterior chest wall identified, despite history of left mid clavicular line stabbing. No bony injury identified.

Conclusion

Type B aortic aneurysmal dissection with intimal flap seen extending to the T10 level.

Case Discussion

Dissecting aortic aneurysm - type B.

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