PMC7240901_01
Maximum intensity projection of the reformatted sagittal image of the thoracic aorta shows interruption of the aortic arch just distal to the subclavian artery origin (black arrow), interruption of descending aorta (white arrow) and fibrotic and stretched arterial duct (curved white arrow)
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F1
The CTA study showed a complete interruption of aortic arch distally to subclavian artery origin [Figures 1 and 2A], reported as type A IAA. Arterial duct appeared fibrotic and partially calcified [Figure 1 and 2A].
(A) Sagittal volume-rendered-image shows cranial (black arrow) and caudal (white arrow) sites of interruption, the fibrotic and stretched arterial duct (curved arrow), enlarged internal mammary arteries (arrowheads) and aneurysms of collateral vessels of left subclavian artery (asterisks). (B) Posterior coronal volume-rendered-image shows right aneurysm (asterisk) proper of a subclavian artery collateral vessel, large bilateral collateral vessels connecting subclavian arteries with descending segment of the thoracic aorta (white arrows) and enlarged internal mammary arteries (arrowheads)
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F2
The CTA study showed a complete interruption of aortic arch distally to subclavian artery origin [Figures 1 and 2A], reported as type A IAA. Arterial duct appeared fibrotic and partially calcified [Figure 1 and 2A]. The thoracic descending aorta was bilaterally refilled, distally to interruption, by collaterals of subclavian arteries arisen after vertebral arteries origin [Figure 2B]. Both collateral arteries presented proximal voluminous aneurysms, the biggest on the right side with endoluminal dissection flap [Figures 2B and 3A] and at least three on the left side [Figure 2A]. Collateral circulation was evident from the internal mammary artery, in particular, the left one [Figure 2A and B].
(A-C): (A) Maximum intensity projection of the reformatted coronal image of maximum craniocaudal extension of the right aneurysm (asterisk), the right subclavian artery (RSA) and the dissection flap of the collateral artery proximal to the aneurysm (white arrow). (B) Reformatted axial image shows enlarged ascending aorta (marked a) measured at the level of pulmonary artery trunk. (C) Reformatted view through the plane of the aortic valve shows bicuspid aortic valve morphology (black arrows). LA, left atrium; RA, right atrium
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F3
Both collateral arteries presented proximal voluminous aneurysms, the biggest on the right side with endoluminal dissection flap [Figures 2B and 3A] and at least three on the left side [Figure 2A]. Aortic root showed a bicuspid aortic valve morphology [Figure 3C] with thick and calcified valvular flaps and an enlargement of the tubular segment of the ascending thoracic aorta [Figure 3B] was reported.