A 76-year-old man, with a long story of hypertension, arrived at the emergency room with sudden severe tearing thoracic pain, tachycardia and progressive hypotension. Few minutes after his arrival he lost consciousness.

CT images taken.


What is the diagnosis?

ANSWER

Acute aortic dissection
CT imaging reveals a dissection involving the ascending aorta.

Acute aortic dissection is the most common emergency affecting the aorta; its prevalence exceeds that of ruptures of thoracic and abdominal aneurysms combined. Untreated, acute aortic dissection can rapidly be fatal.
Patients with hypertension or connective tissue disorders such as Marfan syndrome, cystic medial necrosis, Ehlers-Danlos syndrome and Turner syndrome are at risk for aortic dissection. Pregnancy, aortic stenosis, and coarctation of the aorta are other risk factors.

Stanford classification is the widely used. Regardless of the site of intimal tear or the distal extent of the dissection, dissections involving the ascending aorta (Stanford type A) usually require emergency surgical repair (because of the risk of acute aortic insufficiency, occlusion of the coronary vessels or rupture of the dissection into the pericardium), whereas dissections that are distal to the left subclavian artery (Stanford type B) usually can be controlled medically, unless there is aortic ropture or renal or visceral vascular compromise.

CT is a rapid, relatively noninvasive, and readily available method for evaluation of acute aortic dissection. It is 93.8% sensitive and 87.1% specific. The classic features of AAD on CT scans are an intimate flap and false lumen, which are found in approximately 70% of cases; demonstration of an intimate flap is usually conclusive.Secondary findings include increased attenuation of the acutely thrombosed false lumen on scans obtained before administration of contrast material, internal displacement of intimal calcification, mediastinal or pericardial haematoma, delayed enhancement of the false lumen, mural thickening with increased attenuation, and irregular compression of the true lumen by an expanding intramural haematoma or thrombus.


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13 comments

  1. Anonymous Says:
  2. ruptured aortic aneursym?

     
  3. Anonymous Says:
  4. Aortic dissection

     
  5. Anonymous Says:
  6. Possible pulmonary embolism.

     
  7. Anonymous Says:
  8. aortic dissection

     
  9. David Says:
  10. Thoracic aorta dissection

     
  11. Anonymous Says:
  12. pulmonary artery dissection

     
  13. Anonymous Says:
  14. dissecting aortic aneurysm

     
  15. Anonymous Says:
  16. dissection of descending aorta

     
  17. Anonymous Says:
  18. aortic dissection

     
  19. aortic dissection with involvement of the celiac trunk

     
  20. Anonymous Says:
  21. dissection of aorta with celiac axis invovlment

     
  22. Anonymous Says:
  23. Ruptured dissecting thoracic aortic aneurysm( ascending aorta)
    - rupture false lumen of aorta into mediastinum and pleura

     
  24. Anonymous Says:
  25. Ruptured dissecting thoracic aortic aneurysm

     

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