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Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy—Comparison of Emergency Helical CT and Surgical Findings¹

¹ From the Departments of Radiology (S.Y., H.A., M.T., N.Y., M.H.) and Cardiovascular Surgery (K.M., T.A.), Sapporo Medical University, School of Medicine, Japan. From the 1999 RSNA scientific assembly. Received January 14, 2002; revision requested March 5; final revision received September 9; accepted December 10. Address correspondence to S.Y., Department of Radiology, Muroran City General Hospital, Yamate-chou 3-8-1, Muroran 051-8512, Japan (e-mail: satyoshi@chive.ocn.ne.jp).

View larger version (134K): [in a new window]   Figure 1. Type A AD in a 69-year-old woman. Transverse enhanced helical CT scan demonstrates intimal flap (arrowheads) within the ascending and descending aorta, large entry tear (arrow) in the ascending aorta, and bilateral pleural effusion. Entry tear was defined as a split in the intimal flap. Diagnosis of type A (ie, DeBakey type I) AD was confirmed at surgery.

View larger version (150K): [in a new window]   Figure 2a. Type A IMH in a 48-year-old man. (a) Transverse unenhanced CT scan shows cuff of high attenuation (white arrow) within the ascending aorta, internal displacement of intimal calcifications (arrowheads) in the ascending and descending aorta, and pericardial effusion (black arrow). (b) Transverse enhanced helical CT scan clearly demonstrates type A IMH (arrow). Diagnoses of type A IMH and no entry tear were confirmed at surgery.

View larger version (151K): [in a new window]   Figure 2b. Type A IMH in a 48-year-old man. (a) Transverse unenhanced CT scan shows cuff of high attenuation (white arrow) within the ascending aorta, internal displacement of intimal calcifications (arrowheads) in the ascending and descending aorta, and pericardial effusion (black arrow). (b) Transverse enhanced helical CT scan clearly demonstrates type A IMH (arrow). Diagnoses of type A IMH and no entry tear were confirmed at surgery.

View larger version (122K): [in a new window]   Figure 3. Type A AD in a 69-year-old man. Transverse enhanced helical CT scan demonstrates intimal flap (open arrow) and entry tear (arrow) in the ascending aorta. There was a high-attenuation fluid collection (arrowhead) in the anterosuperior pericardial recess (ie, superior sinus), and this finding indicated recent hemopericardium. Diagnoses of type A (ie, DeBakey type I) AD and bloody pericardial effusion were confirmed at surgery.

View larger version (109K): [in a new window]   Figure 4a. Type A AD in a 48-year-old man. (a) Transverse enhanced helical CT scan shows entry tear (arrow) in the aortic arch. (b) Coronal and (c) sagittal reformations clearly show entry tear (arrow) in the aortic arch proximal to the origin of the left subclavian artery. At surgery, entry tear was confirmed in the aortic arch, and graft replacement of the ascending aorta and total aortic arch was performed.

View larger version (99K): [in a new window]   Figure 4b. Type A AD in a 48-year-old man. (a) Transverse enhanced helical CT scan shows entry tear (arrow) in the aortic arch. (b) Coronal and (c) sagittal reformations clearly show entry tear (arrow) in the aortic arch proximal to the origin of the left subclavian artery. At surgery, entry tear was confirmed in the aortic arch, and graft replacement of the ascending aorta and total aortic arch was performed.

View larger version (136K): [in a new window]   Figure 4c. Type A AD in a 48-year-old man. (a) Transverse enhanced helical CT scan shows entry tear (arrow) in the aortic arch. (b) Coronal and (c) sagittal reformations clearly show entry tear (arrow) in the aortic arch proximal to the origin of the left subclavian artery. At surgery, entry tear was confirmed in the aortic arch, and graft replacement of the ascending aorta and total aortic arch was performed.

View larger version (130K): [in a new window]   Figure 5a. Type A IMH in a 75-year-old man. (a) Transverse enhanced helical CT scan at the level of the aortic arch shows a small entry tear (arrow), which appears as an ulcerlike projection, within IMH in the upper descending aorta distal to the origin of the left subclavian artery. (b) Transverse enhanced helical CT scan at the level of the main pulmonary artery shows type A IMH with mediastinal hemorrhage (arrow). At surgery, entry tear was confirmed in the descending aorta.

View larger version (133K): [in a new window]   Figure 5b. Type A IMH in a 75-year-old man. (a) Transverse enhanced helical CT scan at the level of the aortic arch shows a small entry tear (arrow), which appears as an ulcerlike projection, within IMH in the upper descending aorta distal to the origin of the left subclavian artery. (b) Transverse enhanced helical CT scan at the level of the main pulmonary artery shows type A IMH with mediastinal hemorrhage (arrow). At surgery, entry tear was confirmed in the descending aorta.

View larger version (119K): [in a new window]   Figure 6. Type A AD in a 67-year-old man with a faint left radial pulse, which shows diminution. Transverse enhanced helical CT scan shows arch branch vessel involvement of dissection (arrowheads) into three vessels. These findings were confirmed at surgery.