IS Case 69: Type A Aortic Dissection

Richard Gong, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-19

History

A 65-year-old male presented to the emergency department after cardiac arrest and resuscitation.

Findings

Non-contrast and contrast enhanced images through the thoracic aorta demonstrate an intimomedial flap extending from the ascending aorta into the aortic arch. There is contrast within the true and false lumen. There is no involvement of the aortic root.

Diagnosis

Type A Aortic Dissection

Discussion

Transmission computerized tomography (TCT) has become the examination of choice for the initial evaluation of any patient suspected to have an aortic dissection. Other imaging options for detecting aortic dissection include echocardiography, especially transesophageal, MRI, and aortography. The hallmark for aortic dissection on CT is an intimomedial flap with contrast in the true and false lumina.

There are three classification systems for describing aortic dissection. The first was described by DeBakey, et al. in 1964 based on the anatomic location of the abnormality.

In 1970 the Stanford-Daily classification system was developed and is currently the more commonly used system.

This system is in favor in part because it serves as a basis for management. Most commonly Type A aortic dissections are treated surgically and type B aortic dissection are treated medically.

In 1999 Sevensson proposed a variant system in an attempt to describe the pathologic origin of acute aortic injury at presentation.

References

  1. Petasnick JP. Radiologic evaluation of aortic dissection. Radiology. 1991 Aug;180(2):297-305. [PMID: 2068287]
  2. Hayter RG, Rhea JT, Small A, Tafazoli FS, Novelline RA. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology. 2006 Mar;238(3):841-52. [PMID: 16452396]

3 images