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Circumferential aortic dissection

N A Choh¹, S A Choh², B Naikoo³, S A Bhat¹, M Jehangir¹

¹ Department of Radiology, SMHS Hospital, Srinagar, India
² Department of Pediatrics, SKIMS, Soura, Srinagar, India
³ Department of Cardiology, SMHS Hospital, Srinagar, India

Correspondence to:
suhilchoh{at}rediffmail.com

An adolescent otherwise healthy male presented with acute onset chest pain. Physical examination was remarkable for early diastolic murmur of aortic regurgitation. Transthoracic and subsequently transoesophageal echocardiography revealed aortic dissection extending to the arch. CT angiography revealed a circumferential type of aortic dissection extending from the aortic root to the arch (type A) with extension of the dissection flap into the right brachiocephalic artery (fig 1).

View this figure (111K): in this window | in a new window | PowerPoint for Teaching   Figure 1 Enhanced CT shows an intimal flap in the ascending aorta.

 

The typical aortic dissection appears on contrast enhanced CT as an intimal flap that separates the false from the true lumen. Features indicative of a true lumen are outer wall calcification and eccentric flap calcification; beak sign, larger cross sectional area and slow enhancement are indicators of a false lumen.^1–4 In some instances, an atypical configuration of intimal flap is encountered. These include a calcified false lumen in chronic cases, an aorta with three or multiple channels, an extremely narrow true lumen, or rarely, as in the present case, a circumferential intimal flap.^{1 3} The latter may be further complicated by intimointimal intussusception, although this was not evident in our case.⁵

This article has been adapted from Choh N A, Choh S A, Naikoo B, Bhat S A, Jehangir M. Circumferential aortic dissection Archives of Disease in Childhood 2008;93:581

Competing interests: None.

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5. Nelson, KM, Spizarny, DL, & Kastan, DJ. Intimointimal intussusception in aortic dissection: CT diagnosis. AJR Am J Roentgenol 1994; 162: 813–14.[Free Full Text]

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