Cases/VascularCardiac
Case 1012

Aortic dissection (Stanford type A)What is the diagnosis?

Case image 1 CT 1 / 1

Axial contrast-enhanced CT with colour overlay and numbered labels from the original source.

Image: J. Heuser, CC BY-SA 3.0 — source

Answer hidden. Review the images and history, decide on your diagnosis, then reveal.

Findings

  • The ascending aorta is divided by an intimal flap into two lumens (regions 1 and 2)
  • The descending aorta (region 4) lies beside the vertebral body (region 5)
  • Involvement of the ascending aorta makes this a Stanford type A dissection

Case discussion

An intimal flap separating a true and a false lumen is the defining CT feature of aortic dissection. Any involvement of the ascending aorta (Stanford type A) is a surgical emergency because of the risk of rupture, tamponade, aortic regurgitation and coronary involvement.

Always trace the flap into the arch branches, the visceral and renal arteries, and look for malperfusion.

Encyclopedia

Aortic dissectionA tear in the aortic intima that lets blood split the media, creating true and false lumens separated by an intimal flap.

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