CTICasesType A Aortic Dissection with Acute Bilateral Lower Extremity Paralysis and Retroperitoneal Hematoma
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Imaging findings
A middle-aged man presented with acute onset bilateral lower extremity paralysis. CT revealed a type A aortic dissection, potentially involving the aortic root (evidenced by blood along the pulmonary artery). The dissection extended distally, with a flap identified at the celiac axis and into the SMA. Critically, arterial and delayed venous phase imaging showed complete loss of opacification in the infrarenal aorta and iliacs, leading to lower extremity devascularization. A retroperitoneal hematoma suggested an aortic or iliac rupture.
Key takeaways
Type A aortic dissection can present with acute bilateral lower extremity paralysis due to abrupt occlusion of the infrarenal aorta, a severe manifestation resembling Leriche syndrome. This case demonstrates the extensive reach of aortic dissection and its potential for catastrophic complications, including lower limb compartment syndrome, rhabdomyolysis, and multiorgan failure, emphasizing the need for prompt recognition and intervention.
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