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Findings

Aorta

• dissecting intimal flap extending from the aortic root to the aortic arch with a typical double-lumen appearance

• large false lumen on the right compressing the smaller true lumen on the left

• intimal entry tear in the aortic root in the transition area of the left sinus of Valsalva and the noncoronary sinus

• two re-entry tears in the aortic arch: the first, between the origins of the brachiocephalic trunk and the left common carotid, and the second, distal to the origin of the left subclavian artery

• the coronary arteries, the left common carotid and the left subclavian artery originate from the true lumen; the brachiocephalic trunk originates from the false lumen

• intramural hematoma along the posterior aspect of the ascending aorta

Pulmonary arteries, mediastinum, and lungs

• high-density fluid along and around the pulmonary trunk and both pulmonary arteries with a relatively narrow lumen of the right pulmonary arteries

• probably extravasation of blood into the pulmonary recesses and transverse pericardial sinus

• fat stranding and non-enlarged lymph nodes in the mediastinum

• mild alveolar ground glass opacities around the superior segmental artery of the right lower lobe indicating alveolar haemorrhage

Heart and coronary arteries

• left coronary dominance

• hypoplastic right coronary artery

• both the left main coronary artery and right coronary artery originate from the true lumen

• no evidence of coronary artery dissection

• no coronary occlusion or stenosis

• cardiac chambers not dilated

• no relevant pericardial effusion

Impression

• aortic dissection from the aortic root to the aortic arch, Stanford type A

• intimal tear in the posterior aortic root, two re-entry tears in the aortic arch

• posterolateral aortic intramural hematoma

• associated pulmonary artery intramural hematoma