32 year old female with known descending aortic dissection now with abdominal pain/vomiting. Please evaluate for acute process. CHEST:LUNGS AND PLEURA: Moderate (right greater than left) pleural effusion with overlying compressive atelectasis/consolidation.MEDIASTINUM AND HILA: Reidentification of type A aortic dissection with adjacent pericardial hematoma appearing similar to prior study with stable mass effect on the right atrium. Stable intramural hematoma within the proximal aorta.Presumed post surgical changes at the aortic root are unchanged.Intimal flap extends into the left common carotid artery and down the descending thoracic aorta, unchanged.CHEST WALL: Median sternotomy wires. ABDOMEN: LIVER, BILIARY TRACT: Fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subtle asymmetrically decreased enhancement of the left kidney, which is perfused by the false lumen of the aorta.RETROPERITONEUM, LYMPH NODES: Vascular findings: The intimal flap extends into the celiac artery and the common hepatic artery the SMA and supplied by the true lumen. The right renal artery supplied by the true lumen; the left renal artery and IMA are supplied by the false lumen.The dissection flap extends into the left common iliac artery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca. OTHER: Small amount of free fluid.
1. Stable type A aortic dissection as detailed above. Intramural hematoma at the proximal aorta as well as pericardial hematoma are unchanged.2. Subtle asymmetrically decreased enhancement of the left kidney, which is perfused by the false lumen of the aorta.3. Stable right greater than left pleural effusions and bibasilar atelectasis and consolidations.