PMC4817203_01
Admission AP frontal chest radiograph demonstrating extensive pulmonary oedema as well as widening of the superior mediastinum.
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F1
The admission chest radiograph revealed pulmonary oedema and a widened mediastinum (Fig. 1), with the lateral film confirming dilatation of the descending thoracic aorta.
Oblique sagittal MIP reconstruction shows a diffusely aneurysmal descending thoracic aorta with complex multi-level dissection flaps.
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F2
A computerised tomographic angiogram (CTA) showed that the descending thoracic aorta was aneurysmal throughout its course (maximum diameter 46 mm), with multiple complex dissection flaps (Fig. 2).
Volume-rendered CT reconstruction shows the aneurysmal abdominal aorta as well as aneurysmal origin of the left renal artery with focal stenosis.
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F3
Both renal arteries arose from the lobulated aneurysm and the left renal artery origin was noted to be aneurysmal (Fig. 3).
Mild intimal thickening with disruption of the internal elastic lamina is shown on this haematoxylin and eosin stain (200x magnification).
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F4
Histology of the left renal artery, as demonstrated in Fig. 4, Fig. 5 and Fig. 6, showed mucin accumulation within the intimal and medial layers with disruption of the elastic laminae.
The Elastic von Gieson stain highlights fragmentation of the elastic fibres (400x magnification).
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F6
Histology of the left renal artery, as demonstrated in Fig. 4, Fig. 5 and Fig. 6, showed mucin accumulation within the intimal and medial layers with disruption of the elastic laminae.