Presentation
Sudden onset chest and epigastric pain. Associated leg numbness, no weakness. Background type 2 diabetes, hypertension. Normal ECG.
Patient Data
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Dissection of the ascending and descending thoracic aorta, extending from the aortic root to just proximal to the aortic bifurcation.
Ectatic ascending aorta, and displacement of the calcified lumen apparent on the pre-contrast study.
The left coronary artery is supplied by the true lumen. Cardiac motion limits interpretation of the right coronary vessels.
Dissection flap extends into both common carotid arteries within the scanned extent. Both subclavian arteries appear normal.
The dissection extends into the celiac and superior mesenteric arteries. The left kidney is mainly supplied by a vessel arising from the false lumen (although there is a small intimal defect and an accessory artery) and enhances less than the normal right kidney.
Normal iliacs.
Case Discussion
Stanford type A aortic dissection.
Extension into both carotids, celiac axis and SMA, with supply to the left kidney largely from the false lumen.
Although surgery was considered feasible, it was agreed between the surgical team, patient and family to manage this conservatively. The patient died shortly after.
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