Type A Aortic Dissection and Non-Contrast Computed Tomography

Non-contrast enhanced chest computed tomography (CT) carries a low sensitivity for acute aortic dissection; CT Angiography remains the gold standard. We highlight the potential utility of non-contrast CT for detection of aortic dissection in a case of a young, immunocompromised man presenting with acute abdominal pain and renal injury. Given elevated creatinine, an initial non-contrast chest CT demonstrated subtle findings suggestive of aortic dissection (aneurysmal dilation of the proximal ascending aorta as well as displaced calcified intimal flap/intraluminal high linear density in the thoracic descending and distal abdominal aorta). Subsequent CT angiography confirmed the presence of an extensive type A aortic dissection. He underwent emergent exploratory laparotomy and hemiarch repair. Displaced calcified intimal flaps, intraluminal high-densities, intramural hematoma, and aneurysmal aortic dilation are common non-contrast computed tomography imaging findings that suggest aortic dissection.