CT of calcified chronic aortic dissection simulating atherosclerotic aneurysm.

Calcification along the outermost aspect of the aorta usually means atherosclerotic aneurysm. On occasion, however, this peripheral type calcification is seen in chronic aortic dissection and leads to a misdiagnosis. Conventional chest roentgenography and CT of 50 cases of chronic dissection proven by angiography were reviewed. Four of these cases (8%) showed calcification in the outermost wall of the affected portion of the aorta. Two cases were Stanford type A and the other two cases were type B. In type A cases chest roentgenography showed calcification in the wall of the dilated ascending aorta closely mimicking aneurysm. In type B cases, calcification was in the outer wall of a localized hump in the descending aorta. Computed tomography clearly demonstrated that this peripheral calcification was located in the outermost wall of the false lumen. Review of the pathologic literature shows sporadic reports of such phenomenon and a theory of endothelialization of the false lumen. It is presumed that the endothelialized false lumen may develop atheromatous changes much more rapidly than the true lumen since two of four cases showed calcification only in the wall of the false lumen with the intimal flap and the wall of the true lumen remaining noncalcified.