CT - CT aorta
Axial C+ arterial phase
Coronal C+ arterial phase
Sagittal C+ arterial phase
What is an arteria lusoria?
An aberrant right subclavian artery, arising as the fourth (=last) branch from the aortic arch rather than the first branch. It's course is usually dorsal to the trachea (95%) and dorsal to the esophagus (80%).
What are the two types of dissection according to the Stanford classification?
Type A, with involvement of the ascending and/or the aortic arch. Type B, with involvement limited to the aorta distal to the aortic arch including its branching vessels.
A new classification of dissections involving the aortic arch but not the ascending aorta has been proposed. Why is this, and what's the proposed terminology?
This is because such involvement usually does not require surgical treatment, which a classification of a dissection as type A might imply. The proposed terminology for this pattern of spread is "Type B with aortic arch involvement".
There is a dissection of the aorta, beginning just distal of the aortic arch vessels. The dissection spreads in a retrograde fashion to an aberrant right subclavian artery (arteria lusoria) that passes dorsal to the esophagus and the trachea. The dissection of this vessel continues all the way to the subclavian and axillary arteries, as far as they can be traced. There is no involvement of the other aortic arch branches, nor of the ascending aorta.