LAUSR

A 77-year-old man with a history of chronic hypertension was urgently referred to the emergency department with thoraco-abdominal pain. Clinical examination was unremarkable and included a blood pressure of 104/50 mmHg, heart rate of 84 beats per minute, and symmetrically palpable pulses. Thoraco-abdominal multidetector computed tomographic angiography demonstrated an uncomplicated type-B thoraco-abdominal aortic dissection with three lumens separated by intimal flaps: two false lumens (anterior and left side) and one true lumen (right side). This radiographic finding has been likened to the MercedesBenz mark (Panel A: arrowhead). As this triple-barreled type-B aortic dissection was uncomplicated, the patient was treated conservatively (medical treatment). Triple-barrel dissection is a very rare sub-form of aortic dissection due to rupture of the outer lamina of the false lumen that is very thin and fragile. This unusual dissection often complicates Marfan’s syndrome.1 It generally manifests within the descending thoracic and/or abdominal aorta2 and is characterized by three lumens divided by two intimal flaps that create an appearance of the ‘Mercedes-Benz brand’. When affected patients are hemodynamically stable and without organ malperfusion, medical therapy is utilized.3,4 In all other cases, endovascular and surgical therapy become necessary.5