CT Imaging Features of Acute Aortic Syndrome: A Case Series

Acute aortic syndrome (AAS) encompasses a spectrum of life-threatening aortic pathologies, including aortic dissection, intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Due to overlapping and often nonspecific clinical presentations, timely and accurate imaging is essential for diagnosis and management. Multidetector computed tomography (MDCT) has emerged as the gold standard imaging modality for the evaluation of AAS, due to its rapid acquisition, high spatial resolution, and ability to assess the entire aorta and its branches in a single acquisition. This case series presents four distinct cases of AAS to highlight the critical role of MDCT in diagnosis and treatment planning. The first case is of aortic dissection (Stanford type A) extending into the iliac arteries with a thrombosed false lumen. The second case demonstrated an IMH (Stanford type B) with an ulcer-like projection and associated PAU. The third case shows a PAU (Stanford type B/DeBakey type III) in the infra-renal aorta, while the fourth involved a ruptured Stanford type B dissection with hemomediastinum and hemothorax. All patients underwent MDCT aortography with pre- and post-contrast phases, enabling detailed visualization of the aortic wall, lumen, branch vessels, and associated complications. Non-contrast imaging was pivotal in detecting acute hemorrhage, while contrast-enhanced phases allowed clear visualization of intimal flaps, true and false lumens, ulcerations, and involvement of branch vessels. This series highlights the indispensable role of MDCT in the early recognition and characterization of AAS, enabling prompt intervention and significantly reducing morbidity/mortality.