Favorable aortic remodeling following type B aortic dissection in a patient with osteogenesis imperfecta

Osteogenesis imperfecta is a heritable type I collagen disorder, with aortic dissection a recognized complication. A 69-year-old man with osteogenesis imperfecta presented with acute uncomplicated type B aortic dissection with a thrombosed false lumen, managed with anti-impulse therapy targeting systolic blood pressure < 120 mm Hg and heart rate < 70 beats/min. Despite an ulcer-like projection and 4.2 cm proximal descending aortic diameter, serial imaging demonstrated complete resolution with optimal medical therapy by 6 months and reduction to 3.2 cm at 12 months. This favorable remodeling is notable given the underlying collagen disorder, where tissue fragility raises concerns about impaired healing and aortic integrity.