PMC4899575_01
54-year-old male with subclavian artery dissection. CT of the head. Hypodensity in the left PICA distribution (A) and the right occipital lobe (B) that is secondary to acute infarction.
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CT of the head was repeated and showed acute infarctions of the left cerebellar hemisphere and the right occipital lobe, with no hemorrhagic transformation (Fig. 1).
54-year-old male with subclavian artery dissection. CT angiography. A and B are sequential axial slices that demonstrate a dissection of the subclavian artery (S) at the mid portion, which involves the origin of the vertebral artery (V). C and D are sequential coronal slices; note the normal enhancement of the true lumen (TL), and nonfilling of the false lumen (FL). On B, note the curviilinear hyperdensity in the anterior aspect of the subclavian artery, representing contrast undermining the intimal flap.
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After further review of the CT and angiography of the neck performed at the outside facility, a dissection of the subclavian artery was suspected (Fig. 2).
54-year-old male with subclavian artery dissection. Digital subtraction angiography. A: Arch aortogram demonstrating a region of linear partial filling (arrow) within the mid subclavian artery, compatible with dissection. The left vertebral artery is not seen. B: Dedicated left subclavian arteriogram again shows the dissection (arrow) of the mid subclavian artery, which is confined to the mid portion, and involves the origin of the left vertebral artery.
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Four-vessel cerebral arteriography confirmed a dissection of the left subclavian artery at the mid portion, involving the origin of the vertebral artery (Fig. 3).