CTICasesAortic Intimo-Intimal Intussusception
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Imaging findings
A young, morbidly obese patient presented with chest pain. Imaging showed what appeared to be a dissection flap at the aortic root, but no further dissection in the descending aorta. Distally, there was occlusion of the left subclavian vein and a "ball" of soft tissue. Surgical findings confirmed a circumferential tear at the aortic root, with the intima and most of the media retracting into a ball-like structure (intussusception). The ascending aorta distal to the tear was paper-thin, composed mainly of adventitia with a small medial layer. The "ball" of tissue obstructed the left subclavian vein and extended into the right brachiocephalic artery.
Key takeaways
Aortic intimo-intimal intussusception (also called "aortic inception") is a rare but dramatic complication of a circumferential aortic tear, where the inner layers of the aorta roll up into a ball, potentially obstructing brachiocephalic vessels or prolapsing into the left ventricle. The key imaging clue is discontinuous findings: a dissection flap at the root, but no distal dissection, combined with an obstructive mass in the arch vessels.
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