Answer Aortic dissection

The features demonstrated on the CT scan are an aortic intimal flap and a false lumen (which on higher slices starts distal to the left subclavian artery) - the features are typical of a type-B aortic dissection.

Aortic dissection has a peak incidence in the sixth to seventh decade with a male predominance. The associated risk factors are hypertension and medial degeneration. A variety of congenital diseases are associated with dissection and these include Marfan's and Ehlers-Danlos syndrome. Pregnancy and cardiac catheterisation are further risk factors.

The aorta is composed of three layers (intima, media and adventitia) and dissection is characterised by haematoma in the media of the aortic wall. The separation of the intima from the adventitia finally creates a false lumen that continues for a variable distance. If the dissection ruptures through the adventitia haemopericardium or haemothorax can result.

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