Figure 3a. Rupture of a Stanford type A typical aortic dissection in an 18-year-old patient with aortic coarctation. (a) Unenhanced CT scan shows an aneurysm and displaced intima in the ascending aorta. The intima (arrow) is hyperattenuated due to severe anemia. (b) Contrast-enhanced CT scan shows the intimal flap (arrowhead) in the ascending aorta, coarctation (*) in the descending aorta, and substantial collateral circulation through bronchial and intercostal arteries (arrows). Mediastinal hemorrhage and bilateral pleural effusions are also evident.