Introduction: Aortic dissection is an acute life-threatening disorder requiring prompt and precise diagnostic imaging. The main role of surgery in type A dissection is the excision of the primary intimal tear, while in the case of endovascular treatment of type B dissection it is the occlusion of the entry tear. The aim of the study was to assess the initial intimal and additional tears within the thoracic aorta using ECG-gated dual-source computed tomography (DSCT).

Material and methods: 53 patients (39 male, mean age 55.69 years) with thoracic aorta dissections were analyzed. The ECG-gated angio-CT was performed using dual-source computed tomography. The presence, location, and measurements of the initial intimal and additional tears in the thoracic aorta were assessed. The CT results were confirmed by surgical reports or by aortographic results in the case of endovascular treatment.

Results: Out of 53 patients, 42 (79.25%) had type A dissection, and 11 (20.75%) had type B. The initial tear was detected in 98.15% of patients (in 41 patients with type A and in all patients with type B dissection). There was no significant difference between the size of entry in type A and type B dissection (20.07 vs. 12.2 mm, p = 0.14). Additional tears were detected in 12 (28,5%) patients with type A dissection but none were found in patients with type B dissection.

Conclusions: ECG-gated DSCT allows for the assessment of the precise location and size of the intimal tear and to find additional tears. The intimal tears in type A and B dissection can be located in the aortic arch. The size of entry in type A and B dissection is comparable. The additional tears in the thoracic aorta are significantly more frequent in the dissection type A.