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Intimomedial Rupture: A New CT Finding to Distinguish True from False Lumen in Aortic Dissection

¹ All authors: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.

View larger version (123K): [in a new window]   Fig. 1. —61-year-old man with chest pain and acute type A aortic dissection. Axial enhanced CT scan of ascending aorta shows type A aortic dissection with intimomedial tear (arrows) entering false lumen (F) from true lumen (T). DA = descending thoracic aorta, PA = pulmonary artery.

View larger version (86K): [in a new window]   Fig. 2A. —63-year-old woman with severe chest and back pain from acute type A dissection resulting in death 2 days later. Axial enhanced CT scan at level of ascending aorta shows type A dissection with discontinuous dissection flap (arrows) pointing to false lumen (F). T = true lumen, S = superior vena cava.

View larger version (68K): [in a new window]   Fig. 2B. —63-year-old woman with severe chest and back pain from acute type A dissection resulting in death 2 days later. Photograph of gross pathology specimen from corresponding segment of ascending aorta resected at surgery shows intimomedial tear (arrows) erupting from true (T) into false (F) lumen. Arrowheads mark adventitia.

View larger version (67K): [in a new window]   Fig. 3. —72-year-old man with acute type B dissection. Axial enhanced CT scan at level of aortic arch shows type B dissection with intimomedial dissection flap (arrows) and evagination of torn ends of flap into false lumen (F). T = true lumen, asterisk = innominate artery, arrowhead = left carotid artery.

View larger version (107K): [in a new window]   Fig. 4A. —47-year-old man with acute chest pain and type B aortic dissection. Axial enhanced CT scan at level of ascending aorta shows intimomedial entrance tear (arrows) with central true lumen (T) erupting into false lumen (F). True lumen was continuous proximally with lumen of uninvolved ascending aorta (AA), which has similar attenuation.

View larger version (142K): [in a new window]   Fig. 4B. —47-year-old man with acute chest pain and type B aortic dissection. Axial enhanced CT scan at level of superior mesenteric artery (SMA) shows distal extension of dissection flap to abdominal aorta and SMA. True (arrow) and false (F) lumens within proximal SMA are patent and show unequal contrast enhancement. Although true obstruction does not exist in this patient, dissection flap has potential of causing mechanical SMA obstruction (static obstruction). Right and left renal arteries (not shown) arise from markedly narrowed true lumen and larger false lumen, respectively. Decreased right renal perfusion is evident by decreased enhancement of right kidney (RK) compared with left kidney (LK). P = pancreas.

View larger version (59K): [in a new window]   Fig. 4C. —47-year-old man with acute chest pain and type B aortic dissection. Axial (C) and oblique sagittal (D) reformatted gadolinium-enhanced T1-weighted first-pass MR angiograms (TR/TE, 4.9/1.2) of thoracic aorta show discontinuity in dissection flap (arrows), similar to that seen in A, with true lumen (T, C) opening into false lumen (F) posterolaterally. Ascending aorta (AA), descending thoracic aorta (DA, D), and pulmonary artery (PA, D) are also visible.

View larger version (114K): [in a new window]   Fig. 4D. —47-year-old man with acute chest pain and type B aortic dissection. Axial (C) and oblique sagittal (D) reformatted gadolinium-enhanced T1-weighted first-pass MR angiograms (TR/TE, 4.9/1.2) of thoracic aorta show discontinuity in dissection flap (arrows), similar to that seen in A, with true lumen (T, C) opening into false lumen (F) posterolaterally. Ascending aorta (AA), descending thoracic aorta (DA, D), and pulmonary artery (PA, D) are also visible.

View larger version (31K): [in a new window]   Fig. 5. —Illustration shows utility of intimomedial rupture finding in distinguishing true from false lumen in aortic dissection. Top left image shows longitudinal section of aortic lumen; bottom left image is longitudinal section of aortic wall in profile; and images on right are transverse cross-sectional images above (A and B), at (C), and below (D) level of intimomedial entrance tear. True lumen is depicted in red and false lumen, in pink. At level of tear (C) direction of blood flow is from true to false lumen with intimomedial flaps pointing toward false lumen.

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