Presentation
Breathlessness on exertion and left sided chest pain on exertion since 2 days
Patient Data
Evidence of Stanford type B aortic dissection with entry point in mid/anterior aspect of descending thoracic aorta at the level of carina. Dissection flap is spanning from proximal aspect of descending thoracic aorta throughout the abdominal aorta, common and external iliac arteries bilaterally. Features of mural hematoma in distal aspect of aortic arch.
Infrarenal abdominal aorta aneurysm with AP dimension 35 mm. Ascending aorta with caliber up to 37 mm. Descending thoracic aorta with overall caliber up to 34 mm. Celiac trunk, superior mesenteric artery and renal arteries bilaterally are fed by the true lumen. There is a duplex right renal artery arising from false lumen. Inferior mesenteric artery appears to be contrasted from the false lumen.
Case Discussion
At a reported rate of 88-100%, CT scan accurately helps in diagnosing acute aortic dissection. Debakey and Stanford classification systems are commonly used to classify aortic dissection, based on the extent and location of dissection, of which Stanford is preferred owing to its simplicity.
Stanford type A dissection is the involvement of ascending aorta anywhere from the root to the proximal origin of brachiocephalic artery. Rest of the dissections are considered Stanford type B.
Describing the lumen origins of branch vessels is vital for planning management and to avoid end-organ ischemia. Usually true lumen continues with undissected segment of aorta. Beak sign is seen in the false lumen. Cobwebs maybe identified in false lumen. Also, in chronic cases false lumen is prone to thrombosis. Usually the false lumen has a larger size. Identification of true and false lumen is important for surgical or interventional management.
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