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(Circulation. 2000;101:2771.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Magnetic Resonance Imaging and Asymptomatic Aortic Dissection

Stephen G. Worthley, MB BS, FRACP; Gérard Helft, MD, PhD; Zahi A. Fayad, PhD; Valentin Fuster, MD, PhD; Azfar G. Zaman, MB ChB, MRCP, MD; Meir Shinnar, MD, PhD; Juan J. Badimon, PhD

From the Zena and Michael A. Wiener Cardiovascular Institute (S.G.W., G.H., Z.A.F., V.F., A.G.Z., M.S., J.J.B.) and the Department of Radiology (Z.A.F., M.S.), Mount Sinai Medical Center, New York, NY.

Correspondence to Juan J. Badimon, PhD, Director, Cardiovascular Biology Research Laboratory, Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574. E-mail jbadimo@smtplink.mssm.edu

Aortic dissection is a well-known complication of Marfan syndrome. Aortic dissection in patients with Marfan syndrome is associated with aortic root dilatation. As imaging techniques have improved, it has become clear that some patients with Marfan syndrome, in the absence of symptoms, may have evidence of a prior aortic dissection. A 47-year-old white man with documented Marfan syndrome and no prior symptomatology referable to aortic dissection had elective high-resolution MRI of the aorta for an unrelated research project. Importantly, he had no known risk factors for atherosclerotic disease. The MR images showed that his aortic root was not dilated, with a diameter of 36 mm (Figure 1A). His ascending aorta was not dilated, with normal wall thickness and no evidence of an intimal flap (Figure 1B). However, a small defect was evident in the wall of the descending thoracic aorta that was more readily appreciated on magnified views of the region (Figure 2). Proton density–weighted (Figure 2A) and T2-weighted (Figure 2B) images clearly showed a very small but distinct defect within the aortic wall, consistent with a false lumen. Review of the complete series of MR images confirmed a small, limited type B dissection, beginning just beyond the origin of the left subclavian artery and extending distally into the descending thoracic aorta for 5 cm. No communicating channels were identified between the 2 lumens.

View larger version (82K): [in this window] [in a new window]   Figure 1. Axial proton density–weighted MR images obtained with cardiac-gated double inversion recovery fast spin-echo sequence at different levels through thorax. Small aortic . . . [Full Text of this Article]