Demographics:
55 years old, Male
Indication:
Chest pain
Findings
Chest radiograph
- Surgical changes of endograft repair of the distal aortic arch and proximal descending thoracic aorta
- No focal airspace opacification or edema
- Remote bilateral rib fractures
CT
Chest
- Surgical changes of endograft repair of the distal aortic arch and proximal descending thoracic aorta with aneurysmal dilation of the aorta measuring up to 4.5 x 4 cm transaxially in the proximal descending aorta
- Focal area of contrast leakage through the interstices of the graft along the medial aspect of the distal graft in the proximal descending aorta with diffuse soft tissue thickening about the graft
- Left subclavian artery is occluded at its origin with reconstitution near the origin of the left vertebral artery
- Moderate coronary artery calcification
- Minimal atelectasis/scarring in the dependent aspects of both lower lobes
Upper abdomen
- 2 cm left renal cyst
MSK
- No acute findings
Diagnosis
Type III aortic endoleak
Subclavian steal
Sample Report
Small type III aortic endoleak in the proximal descending thoracic aorta. Aneurysmal dilation of the arch and descending aorta measuring up to 4.5 cm in diameter. Soft tissue thickening along the length of the graft is nonspecific and while this could relate to the endoleak, aortitis/endograft infection could have a similar appearance.
Occlusion of the left subclavian artery at its origin with reconstitution likely via reversal of flow in the left vertebral artery (subclavian steal). Recommend nonemergent neck MRA with and without contrast for further evaluation.
Discussion