Aortic dissection

Case contributed by Dr Ayman Alhasan

Presentation

History of cholecystectomy 2 years ago for choledocholithiasis. Abdominal pain - for MRCP to rule out residual CBD stones.

Patient Data

Age: 50 years
Gender: Female
MRI

Two distinct lumina with difference in signal intensity giving an appearance of "double barrel" aorta seen on MRCP sequences.

Diffuse liver steatosis is also noted manifested as a diffuse decrease in signal intensity of the liver on the out-of-phase images compared to in-phase images.

CT

CTA confirmed a (Stanford B) dissection. The dissection starts distal to the origin of the brachiocephalic trunk extending to the left common iliac artery. The false lumen extends into the left renal artery, with reduced perfusion, explaining the decreased enhancement of the kidney when compared to the contralateral side.​ Significant stenosis of the celiac trunk is noted. The SMA is opacified by the true lumen with no significant stenosis.

Case Discussion

It could be said that this was an "incidentally detected" aortic dissection as this lady presented with atypical symptoms. Her abdominal pain was thought to be due to CBD stones and was therefore referred for an MRCP, which revealed the abnormality in the aorta. The subsequent CT revealed a type B dissection. The case underlines the importance of evaluating organs and structures outside of the main field of interest on every study.

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Case information

rID: 57969
Published: 24th Jan 2018
Last edited: 16th Jul 2018
System: Vascular
Inclusion in quiz mode: Included

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