Findings
Chest
- Type A aortic dissection status post graft replacement of the ascending aorta
- Hyperattenuating foci adjacent to the aortic root are favored to represent pledgets
- Dissection flap extends from the anastomosis of the graft with the transverse aorta through the origins of the renal arteries, with the distal extent not evaluated on this study
- Dissection flap extends into the origin of the left subclavian artery without occlusion
- Common origin of the brachiocephalic and right common carotid arteries without involvement by the dissection
- Contrast density is noted throughout the false lumen with multiple fenestrated communications to the true lumen, though there is thrombosis distally in the region of the origin of the right renal artery
- Multifocal atherosclerotic disease, including of the coronary arteries
- Small pericardial effusion
- Heterogeneous thyroid with subcentimeter nodules
- Mild atelectasis/scarring in the right middle lobe and left lower lobe
Upper abdomen
- Hypoenhancement of the left renal parenchyma
- Left renal artery origin is below the inferior border of the image series, but likely arises from the false lumen
- Celiac artery, SMA, and right renal artery arise from the true lumen
- Multiple calcified gallstones
- Hypoattenuating right renal lesion measuring 3.7 cm
MSK
- Median sternotomy changes
- Degenerative changes of the lower thoracic spine
Diagnosis
Type A aortic dissection
Sample Report
Type A aortic dissection status post graft replacement of the ascending aorta. The dissection flap extends from the anastomosis of the graft through origins of the renal arteries (inferior extent not imaged) and into the origin of the left subclavian artery. The false lumen is largely opacified with enhanced blood flow but is thrombosed distally at the level of the renal arteries. While the celiac artery, SMA, and right renal artery arise from the true lumen, the left renal artery likely arises from the false lumen with findings concerning for resultant hypoperfusion of the left kidney.
3.7 cm hypoattenuating right renal lesion which can be further evaluated with nonemergent renal ultrasound.
Discussion