CTICasesType B Aortic Dissection
Imaging findings
CT shows a type B aortic dissection involving the descending thoracic aorta with a long, continuous false lumen tracking deep to intimal calcifications. In contrast-enhanced studies, dense contrast filling is seen sporadically within the false lumen/wall, tracking down to the diaphragm, while the abdominal aorta displays extensive non-dissected atherosclerosis. Additionally, acute bilateral pulmonary emboli are incidentally noted.
Key takeaways
Although distinguishing between a classic type B dissection, intramural hematoma, and a penetrating atherosclerotic ulcer (PAU) can be challenging in a highly atherosclerotic aorta, the extensive length of the second channel is a strong argument in favor of a true aortic dissection rather than a localized PAU. Severe atherosclerosis can sometimes 'weld' the aortic wall layers together, leading to sporadic and irregular contrast filling within the false lumen.
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