CTICasesChronic Aortic Dissection / Aneurysm with Arch Vessel Involvement
Imaging findings
Sequential chest radiographs from 2007 to 2017 show new opacity over the aortic arch on the more recent study, not present on the prior exam. The earlier radiograph showed tracheal deviation and a large cervicothoracic mass from a goiter that was subsequently removed. CT demonstrates a large type B aortic dissection with aneurysmal dilatation extending to involve the arch vessels including the left carotid artery. A questionable intimal injury or fold is seen in the ascending aorta, raising the question of whether this should be reclassified as a type A dissection.
Key takeaways
Chronic aortic dissection with progressive aneurysmal dilatation can develop following an acute event, particularly in hypertensive patients. The classification of aortic dissections as type A versus type B depends on involvement of the ascending aorta and not simply on involvement of arch vessels; extension into arch vessels alone does not constitute type A dissection. Sequential chest radiographs are valuable for identifying new aortic abnormalities such as displaced calcification or new opacity over the aortic knuckle. These cases highlight the importance of proper classification before surgical planning.
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