Stanford type B aortic dissection

  • Ductus diverticulum is a developmental smooth focal bulge/outpouching at the site of aortic isthmus. Unfortunately, it is also a site of ~90% of post-traumatic aortic pseudoaneurysms. In the trauma setting, particularly those cases with positive findings in the chest (like our case with Stanford type B aortic dissection & multiple bilateral rib fractures), the distinction between a ductus diverticulum and an aortic pseudoaneurysm is critically important because of paramount difference in their management. Post-traumatic aortic pseudoaneurysm is a surgical emergency whereas a ductus diverticulum is a normal anatomical variant. Mural calcification, seen in ductus diverticulum, is an important imaging feature, if present (like our case), in differentiating it from pseudoaneurysm, even in the setting of acute trauma. Absence of intimal flap or mural/mediastinal hematoma, are other supportive findings.

  • Stanford type B aortic dissection is managed conservatively/medically with blood pressure control.

  • The patient was hemodynamically stable but had weak right popliteal, and dorsalis pedis pulses and mild numbness in the right lower extremity. The right lower leg and foot were relatively cold as compared to the left side. Due to a lack of vascular surgery and interventional radiological services in our setup, the patient was transferred to the local interventional cardiothoracic center in a stable condition for further evaluation/expert opinion.