EURORAD ESR

Case 9799

Stanford type A aortic dissection: US and CT findings

Author(s)
Accogli S, Aringhieri G, Scalise P, Angelini G, Pancrazi F, Bemi P, Bartolozzi C

Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Italy.
 
Patient
female, 67 year(s)
 
 
  • Figure 1
    US imaging: B-mode and color-Doppler
     

    B-mode ultrasound axial scan of epigastric region showing suprarenal aortic aneurysm (37 mm) and a thin hyperechoic band that separates two different lumens, which assumes the suspect of dissection.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dissection;

    B-mode ultrasound axial scan of the abdominal region (distally than Fig.1 a) showing the diameter of the suprarenal abdominal aortic aneurysm of 37 mm.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dissection;

    B-mode ultrasound axial scan of the abdominal region (distally than Fig.1 b) showing calcification of the intimal flap.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dissection;

    Colour-Doppler ultrasound axial scan showing blood flow within the smaller lumen of the vessel.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Dissection;

    B-mode ultrasound longitudinal scan showing intimal flap and large vascular wall calcifications.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dissection;

    Colour-Doppler ultrasound longitudinal scan showing blood flow between intimal flap and posterior aortic vascular wall.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 2
    CT
     

    Axial Basal CT showing aneurysm of ascending aorta (diameter 70 mm).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Axial Basal CT showing aneurysm of aortic arch (diameter 53 mm).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Axial basal CT showing dilation of abdominal aorta with calcification inside.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dissection;
     
     
  • Figure 3
    Contrast-enhanced CT
     

    Contrast-enhanced arterial phase axial CT showing dissection that involves also superior mesenteric artery, which appears to take off from true lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Dissection;

    Contrast-enhanced arterial phase axial CT showing dissection extending to the left external iliac artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Dissection;

    Contrast-enhanced arterial phase axial CT showing the origin of celiac trunk from false lumen of the dissecting aorta.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Dissection;

    Contrast-enhanced venous phase axial CT confirming US-imaging results of calcification of the intimal flap.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dissection;
     
     
  • Figure 4
    Multi Planar Reformation (MPR)
     

    Sagittal projection in MPR of the Stanford type A aortic dissecting aneurysm showing the intimal flap beginning close to the aortic root and extending with a cranio-caudal spiral progression to abdominal tract.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Dissection;

    Coronal projection in MPR of the Stanford type A aortic dissecting aneurysm involving anonymous trunk and left common carotid artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Dissection;

    Coronal projection in MPR of the Stanford type A aortic dissecting aneurysm showing the intimal flap extending with a cranio-caudal spiral progression to abdominal tract and left renal artery arising from false lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-3D; Special Focus: Dissection;

    MPR CT image showing aortic dissection involving the right common iliac artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Dissection;

    MPR CT image showing aortic dissection involving the left external iliac artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Dissection;
     
     
B-mode ultrasound axial scan of epigastric region showing suprarenal aortic aneurysm (37 mm) and a thin hyperechoic band that separates two different lumens, which assumes the suspect of dissection.
 
B-mode ultrasound axial scan of the abdominal region (distally than Fig.1 a) showing the diameter of the suprarenal abdominal aortic aneurysm of 37 mm.
 
B-mode ultrasound axial scan of the abdominal region (distally than Fig.1 b) showing calcification of the intimal flap.
 
Colour-Doppler ultrasound axial scan showing blood flow within the smaller lumen of the vessel.
 
B-mode ultrasound longitudinal scan showing intimal flap and large vascular wall calcifications.
 
Colour-Doppler ultrasound longitudinal scan showing blood flow between intimal flap and posterior aortic vascular wall.
 
Axial Basal CT showing aneurysm of ascending aorta (diameter 70 mm).
 
Axial Basal CT showing aneurysm of aortic arch (diameter 53 mm).
 
Axial basal CT showing dilation of abdominal aorta with calcification inside.
 
Contrast-enhanced arterial phase axial CT showing dissection that involves also superior mesenteric artery, which appears to take off from true lumen.
 
Contrast-enhanced arterial phase axial CT showing dissection extending to the left external iliac artery.
 
Contrast-enhanced arterial phase axial CT showing the origin of celiac trunk from false lumen of the dissecting aorta.
 
Contrast-enhanced venous phase axial CT confirming US-imaging results of calcification of the intimal flap.
 
Sagittal projection in MPR of the Stanford type A aortic dissecting aneurysm showing the intimal flap beginning close to the aortic root and extending with a cranio-caudal spiral progression to abdominal tract.
 
Coronal projection in MPR of the Stanford type A aortic dissecting aneurysm involving anonymous trunk and left common carotid artery.
 
Coronal projection in MPR of the Stanford type A aortic dissecting aneurysm showing the intimal flap extending with a cranio-caudal spiral progression to abdominal tract and left renal artery arising from false lumen.
 
MPR CT image showing aortic dissection involving the right common iliac artery.
 
MPR CT image showing aortic dissection involving the left external iliac artery.
 
 
 
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