A 65-year-old man with acute chest pain and CXR showing widened mediastinum undergoes CT aortography. Imaging reveals an intimal flap extending from the ascending aorta through the arch. According to Stanford classification, what type of aortic dissection is this?

• A Stanford Type B — confined to descending aorta, managed medically unless complicated
• B Stanford Type A — involving the ascending aorta, requiring emergency surgery ✓
• C DeBakey Type III — limited to descending aorta
• D Intramural hematoma — no intimal flap visible

Explanation

Stanford Type A dissection involves the ascending aorta regardless of where it originates or how far it extends; it is a surgical emergency due to risk of coronary artery involvement, aortic regurgitation, cardiac tamponade, and stroke. Stanford Type B is confined to the descending aorta (distal to the left subclavian artery) and is managed medically with blood pressure control unless complicated by malperfusion, rupture, or rapid expansion. DeBakey classification uses Types I (entire aorta), II (ascending only), and III (descending only).

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

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Written and medically reviewed by the StethoPrep medical team.