Thrombosed aortic dissection complicated by rupture

Case contributed by Arkadi Tadevosyan


Patient presented to ED with sudden onset of severe chest pain and dyspnea

Patient Data

Age: 60
Gender: Female

There is crescent shape filling defect at the level of the sinotubular junction on the anteromedial wall of ascending aorta, mostly consistent with thrombosed falls lumen. Also, there is a large volume of pericardial fluid and compression of cardiac chambers, mostly consistent with ruptured wall and cardiac tamponade. There is no active extravasation. Ascending aorta is dilated measuring 4.2cm.

There is contras reflux to the IVC and azygos system.

Coronary arteries originate from normal location and have no any filling defects.

There is no mediastinal hematoma or hemothorax.

The rest of arteries are fully opacified, calcified plaques are noted in the aortic arch, splenic artery, infrarenal aorta and iliac arteries.

On the oblique projections, there is nicely demonstrated crescent-shaped (beak sign) thrombosed false lumen with wall defect. The intimal flap is not clearly seen but the tear has been confirmed intraoperatively.

Case Discussion

The thrombosed type was defined as aortic dissection without flow in the false lumen of the aorta on contrast-enhanced computed tomography. Surgery was indicated for all cases of type A acute aortic dissection, and central repair operations were performed and diagnoses were proved. The thrombosed type was associated with a significantly higher mean age (69 vs 60 years), a higher incidence of cardiac tamponade and a lower incidence of malperfusion than classic dissection. Entry tears were located in the ascending aorta and the arch with thrombosed type. An intimal tear has been confirmed intraoperatively. Mortality was significantly lower in patients with thrombosed-type dissection (6%) than in those with classic dissection.

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