CT Diagnosis of an Unusual Aortic Dissection with Intimointimal Intussusception: The Wind Sock Sign

Abstract

A unique combination of CT findings is reported in a rare case of aortic dissection with intimointimal intussusception. The CT showed a wind sock-like appearance in the contrast column of the aortic arch, which was felt to be characteristic of the intussuceptum. Complementary CT findings, including proximal flap in the dilated root of the aorta, no mid-ascending aortic flap, a descending aortic flap, and pericardial effusion, enabled establishment of the preoperative diagnosis.

Intimal Dehiscence in the Abdominal Aorta Following Balloon Fenestration for Type B Dissection

“…The radiological manifestations will depend on whether or not the intimal flap circumferentially separates from the media. If the transverse tear is complete, the flap will subsequently migrate downstream and become intussuscepted, prolapsed, or invaginated, producing either a mass or a ''windsock'' appearance on CT. 11,12 Nevertheless, a CT could fail to detect aortic intimal dehiscence if the false lumen is completely filled with thrombi, if a focal dissection is not in the scan plane, or if there is a wide communication between the true and false lumens, particularly if the intimal flap is thin. 6,8 Other CT and TEE findings described for type A dissections complicated with an intussuscepted intima include an intimal flap in the root of the aorta, prolapsing aortic valve with aortic insufficiency, a lack of intimal flap in the ascending aorta, a flipped U-shaped radiolucency or double line in the contrast column that represents the ''windsock'' intussusceptum, and a filling defect in the aortic arch.…”

“…6,8 Other CT and TEE findings described for type A dissections complicated with an intussuscepted intima include an intimal flap in the root of the aorta, prolapsing aortic valve with aortic insufficiency, a lack of intimal flap in the ascending aorta, a flipped U-shaped radiolucency or double line in the contrast column that represents the ''windsock'' intussusceptum, and a filling defect in the aortic arch. 7,[9][10][11] The intussuscepted intimal flap pri- marily contributes to the filling defect and often leads to partial or complete obstruction of the brachiocephalic branches and neurological symptoms. It is believed that the occurrence of intimointimal intussusception after aortic dissection starting at the root of the aorta is due to the maintained elastic properties of the intima in patients who are mostly young and have good cardiac function.…”

“…Computed tomography (CT) has been positive in 4 cases. [9][10][11][12]14 We describe a case of intimal dehiscence involving the descending thoracic and abdominal aorta secondary to endovascular intervention for the management of type B dissection. To our best knowledge, this is only the second reported case 15 of intimal dehiscence associated with endovascular intervention in patients with aortic dissection.…”

Multidetector CT of the thoracic aorta

“…Atypical configurations of an intimal flap, such as a short length of dissection or multiple false channels can also be a problem (Figure 4) [14]. Other atypical configurations of dissection include, a filiform true lumen, dissection with a circumferential intimal flap, a calcified false lumen as may be seen in chronic dissection, and intimo-intimal interssusception [15,16]. One also needs to be aware of the pitfalls that may mimic aortic dissection.…”

Acute Aortic Dissection with Intimal Intussusception: MRI Appearances

“…ntimointimal intussusception is an unusual type of acute aortic dissection, with fewer than 15 cases reported in the English-language literature [1][2][3][4][5][6][7][8][9]. Several reports have described the findings of aortography [1-3, 6, 8], transesophageal echocardiography (TEE) [4,5,8,9], and CT [6][7][8][9], but the MRI findings, to our knowledge, have not been reported. We describe here the MRI findings in a patient with acute aortic dissection with intimointimal intussusception.…”