Real-Time Proximal Extension of Acute Stanford Type B Aortic Dissection During CTA

Figures

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  Visual Summary. Acute Stanford Type B Aortic Dissection Rapidly Progressed to Type A During a Single Computed Tomography Angiography Examination Despite Stable Hemodynamics Serial imaging obtained over several minutes demonstrated proximal extension into the ascending aorta, highlighting the importance of vigilant imaging assessment and the potential limitation of single-phase computed tomography angiography (CTA) when conservative management is initially considered.

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  Figure 1. Real-Time Proximal Extension of Acute Aortic Dissection During CTA (A) Initial arterial-phase CTA demonstrating Stanford type B aortic dissection without definite involvement of the ascending aorta. (B) Delayed-phase CTA obtained approximately 30 seconds later showing new extension of the dissection flap into the ascending aorta. (C) Repeat CTA performed 3 minutes after the initial scan confirming further proximal progression and definitive involvement of the ascending aorta, consistent with Stanford type A aortic dissection. CTA = computed tomography angiography.

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  Figure 2. Sagittal CTA Reconstructions Demonstrating Longitudinal Propagation of the Dissection (A) Early-phase image showing descending thoracic aortic dissection. (B) Delayed-phase image obtained 30 seconds later demonstrating proximal extension toward the aortic arch. (C) Repeat CTA performed 3 minutes later clearly demonstrating involvement of the ascending aorta. Abbreviation as in Figure 1.

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  Figure 3. CTA Confirming Conversion to Acute Stanford Type A Aortic Dissection (A) Axial CTA demonstrating a clear intimal flap within the ascending aorta, consistent with acute Stanford type A aortic dissection. (B) Sagittal CTA reconstruction showing longitudinal extension of the dissection from the ascending aorta toward the aortic arch. (C) Coronal CTA reconstruction demonstrating thrombosis of the false lumen in the descending thoracic aorta. Abbreviation as in Figure 1.