Case #40

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 above the origin of the IMA
  • Extensive intramural hematoma contributing to long segment aneurysmal dilation, measuring 5 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 1.2 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 density 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

• Stanford type B (De Bakey type III) aortic dissection