Extensive aortic dissection: role of CT angiography in diagnosis and planning of management

ABSTRACT

To evaluate the role of CT angiography in the diagnosis and management planning of suspected cases of aortic dissection. Retrospctive study. Department of Radiology, Al Khor Hospital, Qatar. Aortic dissection [AD] is characterized by the splitting of the aortic wall by high-pressure arterial blood entering the media through an intimo-medial entrance tear. Aortic disease contributes an emerging share of the burden of cardiovascular disease. AD is the most frequent cause of aortic emergency, unless it is diagnosed rapidly, and treated, results in death. Two patients with suspected aortic dissection, presenting to the emergency department, underwent CT angiography. This was done using dedicated aortic protocol for which time delay, for enhanced scanning, was achieved using bolus tracking with region of interest on descending thoracic aorta. Retrospective analysis of the images was performed by two radiologists to evaluate findings pertinent to diagnosis and further management planning. The inter-observer agreement in the diagnosis and CT findings of both the cases was 100%. Two male patients aged 37 and 58 years were included in this study. CT angiography images characterized Type of dissection -one Stanford A [Case1] and the other Stanford B [Case 2]; differentiated true from false lumen- both cases; located entry tear [Case 1]; located branch vessel origin and involvements-both cases; Type of branch vessel occlusion static or dynamic [Case1] and complications like medaistinal hematoma with dissection into left pulmonary artery sheath [Case2], acute intramural hematoma [Case2], and renal infract [Case1]. CT angiography for suspected aortic dissection not only diagnoses the condition but also gives relevant details for planning of management