Findings
CXR
- Widening of the superior mediastinum with indistinct margins of the aortic arch
- No focal airspace opacification or edema
- No pleural effusion or pneumothorax
- Cardiopericardial silhouette otherwise normal in size and configuration
CT
Vascular
- Acute aortic dissection extending from the distal arch near the origin of the left subclavian artery through the infrarenal abdominal aorta proximal to the origin of the IMA
- Extensive intramural hematoma contributing to long segment aneurysmal dilation, measuring 4.4 cm in diameter in the distal arch
- No dissection extension into the arch branches
- The celiac artery arises from the false lumen without definite extension of the dissection flap into the vessel origin. Mild narrowing at the origin with poststenotic aneurysmal dilation measuring 1.4 cm. Maintained vascular contrast in the celiac artery and branches
- The SMA arises from the both the true and false lumens with extension of the dissection flap into its origin. Associated intramural thrombus results in severe narrowing, though distal branches opacify with contrast material
- The right renal artery arises from the false lumen and left renal artery arises from the true lumen. Both are well-opacified with contrast material
- Aortobiiliac atherosclerotic calcification without significant stenosis or aneurysm distal to the dissection
Nonvascular
- Small left and trace right low attenuation pleural effusions with overlying atelectasis
- Mild central bronchial wall thickening
- Mild biapical paraseptal emphysema
- Fluid attenuation structure in the left hepatic lobe, likely a cyst
- Diffusely decreased attenuation of the hepatic parenchyma, suggestive of steatosis
- Hepatomegaly
- Relatively high attenuation material layering in the gallbladder, which likely represents sludge
- Nonspecific mild bilateral perinephric stranding
- Mild circumferential bladder wall thickening
- Nonspecific prostatic calcifications
- Mild fatty expansion of the right greater than left inguinal canals
- Bilateral L5 pars defects with grade 1 anterolisthesis of L5 on S1
Diagnosis
Stanford type B (De Bakey type III) aortic dissection
Sample Report
Acute Stanford type B aortic dissection extending from the distal arch near the origin of the left subclavian artery through the infrarenal abdominal aorta proximal to the origin of the IMA. Extensive intramural hematoma contributing to long segment aneurysmal dilation, measuring 4.4 cm in diameter in the distal arch.
Regarding branch vessel involvement, there is no extension into or compromise of the arch branches. The celiac artery and right renal artery arise from the false lumen, but are well opacified with contrast material. The SMA arises from both false and true lumens and the left renal artery arises from the true lumen. Dissection extension into the SMA with intramural hematoma resulting in severe proximal stenosis, though distal branches are well opacified with contrast material. Proximal celiac artery aneurysm measuring 1.4 cm. The IMA is patent.
Small left and trace right low density pleural effusions with overlying atelectasis.
Discussion