Intimal Flap Intussusception into the Innominate Artery of a Bovine-type Aortic Arch in a Acute Type-A Aortic Dissection: A Case Report

Background: Acute aortic dissection is a life-threatening condition that requires prompt diagnosis and immediate surgical intervention. The diagnosis depends primarily on demonstrating an intimal flap in the ascending aorta by preoperative imaging. We present a case of acute type- A aortic dissection with an absent dissection flap in the ascending aorta.Case presentation: A 37-year-old presented with alternating consciousness and cardiogenic shock. His clinical history and findings of echocardiography were suggestive of an acute aortic syndrome; however, the computed tomography did not demonstrate a dissection flap in the ascending aorta. Immediate surgical repair was undertaken. The dissection flap was found to be intussuscepting into the innominate artery.Conclusion: This case report adds to the existing evidence that the absence of an intimal flap in the ascending aorta does not rule out a severe type-A aortic dissection.