Type A Aortic Dissection with Antegrade Intimointimal Intussusception

Abstract

We describe a 60-year-old man with a history of hypertension who presented to an outside emergency department with chest pain and left lower extremity numbness and weakness. Computed tomography (CT) revealed Stanford type A aortic dissection (TAAD), and he was transferred to our institution for emergent open surgical repair. Review of the outside CT showed no dissection flap in the ascending aorta and a complex flap in the proximal descending thoracic aorta consistent with complex intimal transection at the sinotubular junction and intimointimal intussusception. This case presents high-resolution diagnostic and intraoperative images and illustrates the importance of rapid diagnosis and recognition of the potentially complex nature of the aortic dissection to avoid impending hemodynamic deterioration.

Keywords: intimointimal intussusception; type A aortic dissection.

Figure 1

Aortic root dissection. Sagittal (A), coronal (B), and transverse (C) computed tomography showing dissection flap in the aortic root (arrow). Three-dimensional reconstructed computed tomography is provided (D).

Figure 2

Supra-aortic vessel dissection. Sagittal (A) and transverse (B) computed tomography showing brachiocephalic artery dissection (red arrow) and near complete occlusion of the right common carotid artery (blue arrow) due to thrombosis of the false lumen. Dissection of the right subclavian artery (green arrow) is also seen.

Figure 3

Aortic arch dissection. Sagittal (A), coronal (B), and transverse (C) computed tomography showing complex dissection flap at the level of the aortic arch (arrow). Three-dimensional reconstructed computed tomography is provided (D).