CTICasesAortic Dissection with Intimal Intussusception into the Left Ventricle
[...]. Aortic Dissection with Intimal Intussusception into the Left Ventricle. CTICases. Published August 9, 2018. https://str-case-explorer.pages.dev/c/2nxqj
Imaging findings
Echocardiography showed the aortic intimal flap from a proximal aortic dissection prolapsing back and forth through the aortic valve into the left ventricle during the cardiac cycle, forming a wind-sock-like structure with associated aortic insufficiency. CT confirmed a circumferential intimal tear in the ascending aorta with intussusception of the dissection flap: one limb prolapsed antegrade with the direction of blood flow while the other limb intussuscepted retrograde through the valve into the left ventricle in diastole, leaving a short segment of aorta between the two limbs where no intimal flap was visible on axial imaging.
Key takeaways
A circumferential (360-degree) intimal tear in the ascending aorta can allow the dissection flap to intussuscept through the aortic valve into the left ventricle, mimicking a windsock on echocardiography and producing an unusual "empty" aortic segment on CT where no flap is seen because both limbs of the tear have prolapsed away from that level. Recognizing this rare complication, and that the flap's apparent position on CT depends on the cardiac phase at acquisition, avoids confusion when a segment of dissected aorta appears to lack a visible flap.
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