“ Blood under arterial pressure enters a tear in the intima and tracks along in the media. A total of 60% of dissections involve the ascendi...
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Blood under arterial pressure enters a tear in the intima and tracks along in the media. A total of 60% of dissections involve the ascending aorta (Stanford type A and DeBakey type I and II) and will require surgical management.
They mostly originate from the right anterolateral wall of the ascending aorta, just distal to the aortic valve. They are associated with connective tissue disorders (Marfan and Ehlers-Danlos syndromes), bicuspid aortic valves, coarctation, relapsing polychondritis, Behget disease, Turner syndrome, trauma and pregnancy.
PLAIN FILM
• Widened mediastinum (over 8 cm)
• Double aortic contour
• Displacement of aortic knuckle calcification by 10 mm
• May manifest as lower lobe atelectasis
CT
• Dissection flap separating true and false lumens (can be hard to tell which is which).
• The false lumen tends to be larger, enhances more slowly and may be thrombosed. The ‘beak’ sign (wedges around the true lumen) and ‘cobweb’ sign (remnant ribbons of media appearing as slender linear areas of low attenuation) are also clues.
Aortic dissection. CT angiogram demonstrating a dissection of the ascending and descending thoracic aorta— Stanford type A and DeBakey type I.
Red arrow—false lumen of the ascending aorta.
White arrow—true lumen of the descending thoracic aorta
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