Image 3
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Image 3
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The CT shows mild aortic dilatation and a poorly seen intimal flap in the ascending aorta. This reflects the highly mobile nature of the flap in type A dissections (i.e. those affecting the ascending aorta). There is a hint of a flap in the descending aorta and there is evidence of periaortic haematoma and left pleural fluid. Also there is fullness of the oesophageal density, and image 3 shows this in a lower cut with a narrower window. There is a dense ring within a greatly enlarged oesophageal density and this seems likely to have been an extensive sub-mucosal haematoma. The presumption must be that it arose from the haemorrhage from the dissected descending aorta. At operation there was complete dehiscence of the ascending aortic intima with severe disruption of the aortic valve.