There is a hypodense lesion measuring up to 1.7 cm in diameter within the non-coronary aortic cusp consistent with a thrombus. The adjacent leaflet is thickened towards its annular attachment. The coronary aortic cusps are free of thrombus and the origin of the right and left main coronary arteries opacify normally. No coronary artery calcified plaque identified. Right coronary dominance is present. The thoracic aorta has normal calibre and opacification, with no features to suggest dissection. No mediastinal lymphadenopathy. The lungs demonstrate centrilobular emphysematous changes, particularly within the upper lobes. Bilateral apical scarring also noted. The pleural spaces are clear, airways are normal. No suspicious bony abnormality. Imaged superior abdomen is unremarkable.
Conclusion: thrombus within the non-coronary aortic cusp. No CT features to suggest aortic dissection.