An aortic dissection is seen involving the aortic arch distal to the left common carotid artery, extending inferiorly to involve the descending aorta, abdominal aorta and common iliac arteries bilaterally. Involvement of the proximal segment of the left subclavian artery with normal contrast opacification of the artery distal to the stenosis. The process extends more down significant involvement of the left renal artery with non-enhancement of the upper and mid poles of left kidney indicating an infarction. Multiple atheromatous calcifications are noted in the aorta and its iliac branches.