CTICasesAortic Arch Dissection Progressing to Type A
Imaging findings
A type B aortic dissection with slow flow or intramural hematoma in the false lumen extends proximal to the subclavian artery to involve the arch. Followed conservatively, it developed a large broad-based ulcer-like projection (a large intimal defect) in the arch, and two weeks later, with worsening chest pain, progressed to a type A dissection with two channels in the ascending aorta.
Key takeaways
Dissections involving the aortic arch have a higher propensity than ordinary type B dissections to progress retrograde to type A, and a large broad-based ulcer-like projection is an ominous sign portending pseudoaneurysm, rupture, or propagation. This case argues for early consideration of a protective endovascular stent and closer follow-up, as the ulcer-like projection marked the point at which intervention should have occurred.
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