Type A aortic dissection

Case contributed by Craig Hacking

Presentation

Chest pain and hypertension

Patient Data

Age: 75 years
Gender: Male
x_ray

The heart size and shape is within normal limits. There is moderate unfolding of the ascending and descending thoracic aorta. Both lungs are clear, the mediastinum and pleural spaces are normal.

ct

There is aneurysmal dilatation of the ascending aorta measuring up to 5.6 cm x 6.2 cm maximally. The dissection flap arises from the region of the aortic valve/root, which is self limiting and terminates just at the level of the anterior arch. The coronary arteries are perfused by the true lumen with a satisfactory appearance to the arteries bilaterally. There is evidence of periaortic hematoma involving the ascending aorta. Two blebs of contrast are noted extending into what appears to be the aortic wall just distal to the termination of the dissection flap.

Satisfactory enhancement of the vessels arising from the arch. There is satisfactory enhancement of the pulmonary trunk. Satisfactory appearance to the ascending thoracic aorta at the level of the diaphragm. There is a very small pericardial effusion measuring up to 4 mm maximally. Cardiomegaly.

No significant mediastinal, hilar or axillary lymphadenopathy. No pleural effusion.

Exophytic cyst arising from the upper pole of the left kidney. Hyperdense focus within the gall bladder neck suggesting cholelithiasis with an unremarkable appearance of the gallbladder. No free fluid or free gas.

Degenerative changes are noted involving the thoracic spine with flowing ossification present suggesting the presence of DISH. No expansile or lytic osseous lesion.

Conclusion

Type A dissection. Satisfactory enhancement of the left and right main coronary arteries. Periaortic hematoma and small pericardial effusion. Cardiothoracic assessment is recommended.

Case Discussion

When dissection includes the ascending aorta, involvement of the following need to be assessed for :

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