Presentation
Chronic chest pain.
Patient Data
Stanford type B dissection beginning just distal to the left subclavian artery origin. The false lumen is predominantly thrombosed, however, there are few small collections of contrast within the false lumen.
Case Discussion
The CT protocol for aortic dissection (acute or chronic) almost always includes the unenhanced, early arterial and delayed series. Always start with the unenhanced series; identify any areas of hyperdensities these could be related to suture materials in surgically treated cases, calcific plaques or intimal calcification in a chronic dissection flap.
The early arterial series shows a small collection of the contrast within the false lumen at the level of the arch, could be due to continuation with the intercostal arteries about the thoracic inlet.
There are probable fenestrations of the dissection flap at the level of the diaphragmatic hiatus.
Conventional three-vessel aortic arch branching pattern. Celiac artery, superior mesenteric and both renal arteries arise from the true lumen. The dissection flap extends to the LCIA.