CTICasesGiant Ascending Aortic Aneurysm and Chronic Type A Dissection
Imaging findings
Chest radiograph shows a large right mediastinal convexity. Chest CT demonstrates a giant ascending aortic aneurysm (one of the largest seen) with a chronic type A dissection flap, extensive mural calcification, thrombus, and circumferential intimal intussusception extending into the arch vessels, in a 41-year-old man with a family history of dissection.
Key takeaways
Giant ascending aortic aneurysms are associated with genetic aortopathies/elastopathies (e.g. Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos). A complete circumferential intimal tear can lead to chronic dissection and intimal intussusception (peeling of the intima into the arch branches), which can be surprisingly asymptomatic or present with minimal chronic symptoms.
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