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An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
Intimo-intimal intussusception of the aorta.
Pallav J Shah1, Sanjay S Singh, Salim S Chaloob
1Department of Cardiac Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
The Annals of Thoracic Surgery
|November 28, 2006
Summary
A rare form of aortic dissection without a visible intimal flap was diagnosed in a patient presenting with chest pain. This unusual presentation, termed aortic intussusception, challenges standard diagnostic methods for type A dissection.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Surgical Pathology
Background:
- Type A aortic dissection typically involves a visible intimal flap, crucial for diagnosis via imaging modalities like echocardiography, CT, and MRI.
- Accurate and timely diagnosis of aortic dissection is critical for effective management and improved patient outcomes.
Observation:
- A 50-year-old male presented with acute chest pain, initially showing atypical imaging findings for aortic dissection.
- Transesophageal echocardiography and CT scans revealed no flap in the ascending aorta but showed dissection in the arch and descending aorta.
- MRI identified a tear and small flap in the right coronary sinus, with surgical findings revealing a circumferential intimal tear at the sinotubular junction.
Findings:
- The surgical exploration confirmed a rare variant of type A aortic dissection characterized by intimo-intimal intussusception without a distinct intimal flap in the ascending aorta.
- The intussusception involved the internal channel of the dissected aorta extending into the aortic arch.
- This specific presentation, dissection without intimal flap and aortic intussusception, represents a diagnostic challenge.
Implications:
- This case highlights the diagnostic difficulties posed by aortic dissections lacking typical intimal flaps, potentially leading to delayed treatment.
- Advanced imaging and surgical findings are essential for diagnosing rare aortic dissection variants like aortic intussusception.
- Awareness of such atypical presentations is crucial for cardiovascular specialists to ensure prompt and accurate diagnosis and management of aortic dissections.
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