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Case 1332

Acute dissection of thoracic aorta treated with a stent: a suspected residual aortic tear

Author(s)
F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone
 
Patient
female, 50 year(s)

Clinical History

Patient treated with a stent for an acute spontaneous dissection of the thoracic aorta.

Imaging Findings

The patient presented for intravascular treatment of an acute spontaneous dissection of the thoracic aorta (Stanford type B). The entry door was successfully closed with a stent and the false lumen was completely closed. At the 1-week follow-up study with spiral CT an abnormal finding was detected at the level of the isthmus on ventral profile of the aorta. Two options were considered: a residual aortic tear or a small haematoma modifying the profile of the aorta. Further follow-up studies demonstrated the static nature of the image, confirming the diagnosis.

Discussion

Acute aortic dissection is a worrying complication of many diseases, such as: atherosclerotic and degenerative disorders, bicuspid aortic valve, aortic coarctation, pregnancy, connective tissue disorders (Marfan, Ehlers-Danlos), skeletal abnormalities (scoliosis, pectus), mycotic aneurysm, Takayasu arteritis, and aortic traumatic laceration.

Intravascular treatment is becoming a minimally invasive option that can be used even in patients with extensive involvement, for example affecting the whole thoracic aorta. Short- and mid-term complications of the stenting procedure are reported, including: collapse, torsion, mobilisation, kneeing, and thrombosis.

In this case a complication without severe consequences is described. The haematoma created an image that could be misinterpreted as a residual tear. Follow-up examination with spiral CT and clinical examination demonstrated the static nature of the image. Careful follow-up is needed in patients with this complication.

Final Diagnosis

Residual aortic haematoma at the isthmus
 

MeSH

  1. Aorta, Thoracic [A07.231.114.056.372]
    The portion of the descending aorta proceeding from the arch of the aorta and extending to the diaphragm.

References

  1. [1]
    Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ, Miller GL, Summa JA. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am J Roentgenol. 2001;176(5):1267-72..

  2. [2]
    Gavant ML, Menke PG, Fabian T, Flick PA, Graney MJ, Gold RE. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 1995;197(1):125-33..

  3. [3]
    Durham RM, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld WB, Herr DJ, Shapiro MJ, Mazuski JE, Salimi Z, Sundaram M. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994;220(5):699-704..

Citation

F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone (2001, Dec 7).
Acute dissection of thoracic aorta treated with a stent: a suspected residual aortic tear, {Online}.
URL: http://www.eurorad.org/case.php?id=1332
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  • Published 07.12.2001
  • DOI 10.1594/EURORAD/CASE.1332
  • Section Cardiovascular
  • Case-Type Clinical Case
  • Difficulty Senior
  • Views 863
  • Language(s)
  • Figure 1
    Axial images from spiral CT.
    a b c d  

    The aortic arch shows no particular modification.

    At the level of the isthmus on the ventral profile of the aortic wall a hypodense structure, of rounded shape is seen in the lumen. From this image the grid of the stent seems not involved.

    A slightly caudal slice shows the same hypodense structure. No contrast medium can be visualised between the structure and the aortic wall.

    A caudal slice displaying the recovery of the normal profile of the aortic wall.

     
  • Figure 2
    Multiplanar and curved CT reconstructions.
    a b c  

    The oblique multiplanar reconstruction shows clearly the position and configuration of the hypodense structure.

    A slightly different projection from the previous one to show the presence of one grid of the stent behind the structure of interest.

    A curved central lumen line reconstruction to display the entire lumen.

     
Figure 1

Axial images from spiral CT.

Figure 1a
The aortic arch shows no particular modification.
 
Figure 1b
At the level of the isthmus on the ventral profile of the aortic wall a hypodense structure, of rounded shape is seen in the lumen. From this image the grid of the stent seems not involved.
 
Figure 1c
A slightly caudal slice shows the same hypodense structure. No contrast medium can be visualised between the structure and the aortic wall.
 
Figure 1d
A caudal slice displaying the recovery of the normal profile of the aortic wall.
 
Figure 2

Multiplanar and curved CT reconstructions.

Figure 2a
The oblique multiplanar reconstruction shows clearly the position and configuration of the hypodense structure.
 
Figure 2b
A slightly different projection from the previous one to show the presence of one grid of the stent behind the structure of interest.
 
Figure 2c
A curved central lumen line reconstruction to display the entire lumen.
 
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