Transoesophageal echocardiography (TOE/TEE) and CT aortography are performed in a 65-year-old with acute chest pain and back pain. CT shows a dissection flap in the descending thoracic aorta starting at the left subclavian artery takeoff, with the false lumen extending to the iliac arteries. There is no involvement of the ascending aorta. According to the Stanford classification, this is:

• A Stanford Type A dissection — requires emergency surgery
• B De Bakey Type I dissection
• C Stanford Type B dissection — managed medically with antihypertensive therapy unless complicated ✓
• D De Bakey Type II dissection

Explanation

Stanford classification: Type A involves the ascending aorta regardless of origin site (surgical emergency due to risk of pericardial tamponade, aortic regurgitation, coronary malperfusion); Type B does NOT involve the ascending aorta, starts at or distal to the left subclavian artery, and is managed medically with strict blood pressure and heart rate control unless complicated (malperfusion, aneurysmal dilatation, refractory pain). DeBakey Type I involves ascending + descending; Type II involves ascending only; Type III involves descending only.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.