CTICasesLimited (Incomplete) Aortic Dissection with Progressive Evolution
Imaging findings
Serial CT angiograms in an elderly woman with acute aortic syndrome beginning with intramural hematoma of the ascending aorta and brachiocephalic artery demonstrate progressive evolution: initial IMH without a visible intimal flap, followed by development of a subtle focal contour abnormality (mushroom-like bulge) in the medial ascending aorta and later frank dissection extending into the descending aorta with true and false lumens, along with progressive pleural effusions and pericardial fluid.
Key takeaways
Limited (incomplete or localized) aortic dissection is a subtle but dangerous entity in the spectrum of acute aortic syndrome, characterized by a small focal intimal tear without the classic double-lumen appearance of typical dissection. On CT, it appears as a focal mushroom-shaped bulge or contour abnormality of the aortic lumen, usually near the proximal ascending aorta. It is easily missed but may progress to overt dissection on serial imaging. Gated imaging of the ascending aorta improves detection.
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