Pictorial essay: Computed tomography findings in acute aortic syndromes

Figures

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  FIGURE 1. Axial unenhanced computed tomography scan of thorax demonstrating displaced intimal calcification (arrow), suggesting aortic dissection.

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  FIGURE 2. Contrast-enhanced axial computed tomography scan demonstrating a displaced intimal flap (arrow), separating the true and false lumens in a patient with a Stanford Type A aortic dissection.

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  FIGURE 3. (a) Contrast-enhanced axial computed tomography (CT) scan showing intimal calcifications around the true lumen (thick arrow) and linear scattered hypodense areas within the false lumen termed the Cobweb sign (thin arrow), representing the remnants of media. The calibre of the true lumen (T) appears smaller than the false (F). (b) Axial contrast-enhanced CT scan showing a beak sign (arrow) which is a wedge of haematoma at the distal end of false lumen forming an acute angle with the vessel wall.

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  FIGURE 4. Stanford type B dissection with extension into the superior mesenteric artery. Contrast-enhanced computed tomography showing lesser enhancement in the false lumen (*) as compared to true lumen.

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  FIGURE 5. Type A chronic dissection. Contrast-enhanced axial (a) and coronal (b) computed tomography scan showing an ascending aortic aneurysm with chronic dissection. A thin linear low attenuation discontinuous dissection flap (arrow) is seen within the aneurysm.

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  FIGURE 6. Stanford type A intramural haematoma (IMH): (a) Unenhanced axial computed tomography (CT) scan showing hyperdense crescentic aortic wall thickening involving the ascending aorta (arrow); (b) Stanford type A IMH. Unenhanced coronal CT scan showing crescentic hyperdense aortic wall thickening (*) compressing the lumen.

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  FIGURE 7. Type A intramural haematoma. Contrast-enhanced axial (a) and coronal (b) computed tomography scan showing a non-enhancing hypodense crescent-shaped area (arrow) compressing the normal contrast-enhanced aortic lumen.

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  FIGURE 8. Coarctation of the aorta with a type A intramural haematoma (IMH) and aortic dissection. (a) Unenhanced axial computed tomography (CT) scan showing circumferential hyperdense thickening of the ascending aorta (arrow); (b) Contrast-enhanced axial CT showing crescentic non-enhancing hypodense area (thin arrow) representing IMH with haemopericardium (*) and concentric left ventricular hypertrophy (thick arrow); (c) Contrast-enhanced CT scan showing the displaced intimal flap (arrow) and haemopericardium (*). (d) Sudden narrowing of the aorta (arrow) distal to origin of the left subclavian artery on sagittal contrast-enhanced images. Multiple collaterals (thick arrow) along the anterior chest wall.

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  FIGURE 9. Penetrating atherosclerotic ulcer. Contrast-filled outpouching seen beyond the aortic wall involving the arch of the aorta (arrow).

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  FIGURE 10. Ruptured penetrating atherosclerotic ulcer (PAU) with contained haematoma. Contrast-enhanced computed tomography scan of thorax showing a ruptured PAU along the posterior aortic wall (white arrow) with adjacent intramural haematoma (black arrow) appearing as hyperdense aortic wall thickening and a contained haematoma in left pleural space (*). Findings were confirmed at surgery.