1
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Shmukler A, Alis J, Patel S, Latson L, Ko JP. Pitfalls and Pearls of Imaging Non-traumatic Thoracic Aortic Disease. Semin Ultrasound CT MR 2022; 43:204-220. [PMID: 35688532 DOI: 10.1053/j.sult.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging of the thoracic aorta is a common request in both the acute and outpatient settings, playing a crucial role in diagnosis and treatment planning of aortic disease. The findings of aortic pathology may be obvious or occult on imaging. Recognizing subtle changes is essential and may lead to early detection and prevention of serious morbidity and mortality. Knowledge of the anatomy and understanding the pathophysiology of aortic disease, as well as selecting the appropriate imaging modality and protocol will enable prompt diagnosis and early intervention of aortic pathology. Currently, computed tomography angiography and magnetic resonance angiography of the aorta are the most commonly used imaging modalities to evaluate the aorta. This review focuses on a spectrum of aortic pathology manifestations on computed tomography and magnetic resonance, including atherosclerosis and acute aortic syndromes, highlighting diagnostic challenges and approaches to aid in image interpretation.
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Affiliation(s)
- Anna Shmukler
- Department of Radiology, NYU Langone Health, New York, NY.
| | - Jonathan Alis
- Department of Radiology, Jacobi Medical Center, Bronx, NY
| | - Smita Patel
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Larry Latson
- Department of Radiology, NewYork-Presbyterian / Weill Cornell Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, New York, NY
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2
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MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal. Tomography 2022; 8:200-228. [PMID: 35076599 PMCID: PMC8788571 DOI: 10.3390/tomography8010017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.
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3
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Steinbrecher KL, Marquis KM, Bhalla S, Mellnick VM, Ohman JW, Raptis CA. CT of the Difficult Acute Aortic Syndrome. Radiographics 2021; 42:69-86. [PMID: 34951836 DOI: 10.1148/rg.210098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute aortic syndrome (AAS) is classically attributed to three underlying pathologic conditions-aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU). In the majority of cases, the basics of image interpretation are not difficult and have been extensively reviewed in the literature. In this article, the authors extend existing imaging overviews of AAS by highlighting additional factors related to the diagnosis, classification, and characterization of difficult AAS cases. It has been well documented that AAS is caused not only by an AD but by a spectrum of lesions that often have overlap in imaging features and are not clearly distinguishable. Specifically, phase of contrast enhancement, flow artifacts, and flapless AD equivalents can complicate diagnosis and are discussed. While the A/B dichotomy of the Stanford system is still used, the authors subsequently emphasize the Society for Vascular Surgery's new guidelines for the description of acute aortic pathologic conditions given the expanded use of endovascular techniques used in aortic repair. In the final section, atypical aortic rupture and pitfalls are described. As examples of pericardial and shared sheath rupture become more prevalent in the literature, it is important to recognize contrast material third-spacing and mediastinal blood as potential mimics. By understanding these factors related to difficult cases of AAS, the diagnostic radiologist will be able to accurately refine CT interpretation and thus provide information that is best suited to directing management. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - J Westley Ohman
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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4
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Li Y, Zhang N, Xu S, Fan Z, Zhu J, Huang L, Chen D, Sun Z, Sun L. Acute type A aortic intramural hematoma and type A aortic dissection: correlation between the intimal tear features and pathogenesis. Quant Imaging Med Surg 2020; 10:1504-1514. [PMID: 32676368 DOI: 10.21037/qims-20-191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background To determine the prevalence, clinical and imaging features of intimal tear detected by ECG-gated multidetector computed tomography (MDCT) and confirmed by surgery in patients with acute type A intramural hematoma (ATAIMH) and acute type A aortic dissection (AAAD). Methods This retrospective study involved analysis of the intimal tear characteristics in 72 consecutive patients with ATAIMH and 209 with AAAD who were diagnosed by MDCT. The size and location of the intimal tear were measured and compared between these two groups of patients. The findings were also compared with those from 28 patients with ATAIMH who underwent surgical treatment to determine the intimal tear features as observed on CT angiography (CTA). Results Patients in the ATAIMH group were significantly older than those in the AAAD group (58.6±11.3 vs. 49.4±12.8 years, P<0.001), and females were predominant in the former category (ATAIMH vs. AAAD: 44.4% vs. 27.8%, P<0.01). Marfan syndrome and pregnancy were associated with most of the occurrences of AAAD. Sixty-four patients (88.9%) with ATAIMH were recognized as having intimal tear in the CTA images. The number of aortic segments in the ATAIMH patients was smaller than that in the AAAD patients (4.45±1.56 vs. 5.04±1.72 segments, P<0.01). The distribution of the intimal tear did not show any difference between the two groups. During the surgery, pericardial hemorrhage was observed in a higher proportion of patients in the ATAIMH than in the AAAD group (60.7% vs. 22.1%; P<0.01). In the former category, all of the intimal tears detected using CTA were confirmed during the operation, and the size was significantly larger than measured on the CTA images (6.95±5.12 vs. 19.59±6.51 mm, P<0.001). Six ATAIMH patients progressed to classical aortic dissection (AD) at surgery. Conclusions Patients with ATAIMH have a high prevalence of intimal tear, which is significantly smaller than that measured in patients with classic AAAD. Just like AD, ATAIMH may also be triggered by intimal tear. Hence, timely surgical repair is needed.
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Affiliation(s)
- Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shangdong Xu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Lianjun Huang
- Department of Diagnostic and Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
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“Distal bright vessel sign” – Novel radiological sign of pulmonary thromboembolism. Radiol Case Rep 2020; 15:222-225. [PMID: 31908706 PMCID: PMC6938914 DOI: 10.1016/j.radcr.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 11/02/2022] Open
Abstract
We describe a novel radiological sign of pulmonary thromboembolism on computed tomography aortic angiogram. It consists of focal hyperenhancement of pulmonary arteries distal to the pulmonary thrombus, while the thrombus itself remains occult and the rest of pulmonary arteries are hypoattenuating. The sign was observed on computed tomography aortic angiograms in 2 patients assessed for suspected acute aortic syndrome. Pulmonary emboli were subsequently confirmed with computed tomography pulmonary angiography.
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6
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Sathiadoss P, Haroon M, Wongwaisayawan S, Krishna S, Sheikh AM. Multidetector Computed Tomography in Traumatic and Nontraumatic Aortic Emergencies: Emphasis on Acute Aortic Syndromes. Can Assoc Radiol J 2020; 71:322-334. [PMID: 32106708 DOI: 10.1177/0846537120902069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aortic emergencies comprise of a list of conditions which are uncommon but are potentially fatal. Prognosis is usually determined by emergent diagnosis and treatment and hence radiology plays a key role in patient management. In this article, we aim to review the various causes of aortic emergencies and the relevant imaging findings placing special emphasis on acute aortic syndromes.
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Affiliation(s)
- Paul Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Mohammad Haroon
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Sirote Wongwaisayawan
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada.,Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satheesh Krishna
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Adnan M Sheikh
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
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7
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Duran ES, Ahmad F, Elshikh M, Masood I, Duran C. Computed Tomography Imaging Findings of Acute Aortic Pathologies. Cureus 2019; 11:e5534. [PMID: 31687308 PMCID: PMC6819069 DOI: 10.7759/cureus.5534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Acute aortic syndromes (AAS) encompass a spectrum of life-threatening conditions characterized by acute aortic pain. AAS include acute aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aneurysm rupture. The prognosis of AAS is clearly related to prompt diagnosis and appropriate management. The different types of AAS cannot be reliably differentiated solely based on clinical presentation since the clinical features are indistinguishable. Multidetector-row computed tomography (MDCT) with electrocardiographic gating (ECG-gated MDCT) has been used in the acute emergency setting as a powerful clinical tool, which enables rapid and specific diagnosis of aortic pathologies. ECG-gated MDCT significantly reduces motion artifact and avoids potential pitfalls in the diagnosis of AAS. The aim of this review is to evaluate the role of MDCT imaging in the assessment of AAS and to discuss the differentiation of this spectrum of aortic diseases with reference to the key imaging findings.
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Affiliation(s)
- Elif S Duran
- Radiology, University of Texas Health Rio Grande Valley School of Medicine, Edinburg, USA
| | - Farhan Ahmad
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Mohamed Elshikh
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Irfan Masood
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Cihan Duran
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
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8
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Abstract
Multidetector-row computed tomography (MDCT) can provide crucial information and rapid triage of emergency department patients with suspected acute coronary syndrome (ACS) or acute aortic syndrome (AAS). Coronary computed tomography angiography has high negative predictive value to rule out ACS, and MDCT is diagnostic for AAS and its variants. Optimization of acquisition technique and up-to-date knowledge of the pathophysiology of these conditions can improve study and interpretation quality for diagnosis of ACS or AAS.
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Affiliation(s)
- Avanti Gulhane
- Cardiovascular Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Harold Litt
- Cardiothoracic Imaging Division, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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9
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Oderich GS, Kärkkäinen JM, Reed NR, Tenorio ER, Sandri GA. Penetrating Aortic Ulcer and Intramural Hematoma. Cardiovasc Intervent Radiol 2018; 42:321-334. [DOI: 10.1007/s00270-018-2114-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/01/2018] [Indexed: 01/10/2023]
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10
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Distinguishing acute from chronic aortic dissections using CT imaging features. Int J Cardiovasc Imaging 2018; 34:1831-1840. [PMID: 29915877 DOI: 10.1007/s10554-018-1398-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/13/2018] [Indexed: 10/14/2022]
Abstract
The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 patients were reviewed for a variety of imaging features. Statistical tests assessed for differences in the frequency of these features. A predictive model was created and tested on an additional 120 CT scans from 115 patients. Statistically significant features of AAD included periaortic confluent soft tissue opacity, curved dissection flap, and highly mobile dissection flap, and features of CAD included thick dissection flap, false lumen (FL) outer wall calcification, FL thrombus, dilated FL, and tear edges curling into the FL. The model predicted the chronicity of a dissection with an area under the curve of 0.98 (CI 0.98-1.00). AADs and CADs demonstrated significantly different CT imaging features.
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11
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Singh N, Goel P, Singh Y. Pictorial essay: Computed tomography findings in acute aortic syndromes. SA J Radiol 2018; 22:1309. [PMID: 31754495 PMCID: PMC6837812 DOI: 10.4102/sajr.v22i1.1309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/12/2018] [Indexed: 11/04/2022] Open
Abstract
Acute aortic emergencies are life-threatening conditions that may require urgent surgical or interventional management. Imaging plays an important role in the diagnosis and planning of the management, and timely intervention helps in reducing mortality and morbidity.
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Affiliation(s)
- Navdeep Singh
- Department of Radiology, Ivy Hospital, Amritsar, India
| | - Pankaj Goel
- Department of Cardiovascular Surgery, Ivy Hospital, Amritsar, India
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12
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Abstract
Rarely, penetrating atherosclerotic ulcers can rupture into the wall of the aorta, resulting in acute aortic dissection. This article describes a woman with an incidental diagnosis of type A aortic dissection secondary to a penetrating atherosclerotic ulcer of the ascending aorta. Although surgical repair of the aortic root was recommended, the patient refused treatment and left against medical advice.
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13
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Chung J, Lachapelle K, Cartier R, Mongrain R, Leask RL. Loss of mechanical directional dependency of the ascending aorta with severe medial degeneration. Cardiovasc Pathol 2017; 26:45-50. [DOI: 10.1016/j.carpath.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 01/15/2023] Open
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Haji-Momenian S, Rischall J, Okey N, Taffel M, Khati N, Zeman R. CT of suspected thoracic acute aortic injury in the emergency department: is routine abdominopelvic imaging worth the additional collective radiation dose? Emerg Radiol 2016; 24:13-20. [PMID: 27568394 DOI: 10.1007/s10140-016-1435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n = 238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study. The Stanford classification for positive cases of AAI was further subclassified based on chest, abdominal, or pelvic involvement. The dose length product (DLP) of each exam was used to estimate the dose of the abdominal and pelvic stations and the collective effective dose for the population. There were five cases of aortic dissection (AD) and two of intramural hematoma (IMH), with an AAI incidence of 2.9/100. Three cases of AAI were confined to the chest. Two cases of AAI were confined to the chest and abdomen, and two cases involved the chest, abdomen, and pelvis. There was only one case of AAI involving the ascending aorta that extended into the abdomen or pelvis. The number needed to screen to identify (a) AAI extending from the chest into the abdomen or pelvis was 59.5 and (b) Stanford A AAI extending into the abdomen or pelvis was 238. The estimated mean effective dose for the abdominopelvic stations were unenhanced abdomen 2.3 mSv, unenhanced pelvis 3.3 mSv, abdominal CTA 2.5 mSv, and pelvic CTA 3.6 mSv. The collective effective doses to the abdomen and pelvis with unenhanced CT and CTA in 59.5 patients and 238 patients were 761.6 and 3046.4 mSv, respectively. While the estimated mean effective dose for imaging of the abdominopelvic stations are low, the collective effective dose should also be considered. It may be beneficial to modify or omit routine unenhanced CT and/or CTA of the abdomen/pelvis in this patient population in the absence of abdominal symptoms, and image the abdomen and pelvis in positive thoracic cases only.
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Affiliation(s)
- Shawn Haji-Momenian
- Department of Radiology, The George Washington University Medical Faculty Associates, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA.
| | - Jonathan Rischall
- The George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA
| | - Neil Okey
- The George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA
| | - Myles Taffel
- Department of Radiology, The George Washington University Medical Faculty Associates, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Nadia Khati
- Department of Radiology, The George Washington University Medical Faculty Associates, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Robert Zeman
- Department of Radiology, The George Washington University Medical Faculty Associates, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
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15
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Muto M, Molino A, Scaglione M. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol 2016; 89:20150825. [PMID: 27033344 DOI: 10.1259/bjr.20150825] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.
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Affiliation(s)
- Tullio Valente
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Giovanni Rossi
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Francesco Lassandro
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Gaetano Rea
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Marino
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Muto
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Antonio Molino
- 2 Department of Pneumology, Section of Respiratory Diseases, University of Naples Federico II c/o Monaldi Hospital, Naples, Italy
| | - Mariano Scaglione
- 3 Department of Diagnostic Imaging, Presidio Ospedaliero "Pineta Grande", Caserta, Italy.,4 Department of Radiology, Darent Valley Hospital, Darfford, UK
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16
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Vardhanabhuti V, Nicol E, Morgan-Hughes G, Roobottom CA, Roditi G, Hamilton MCK, Bull RK, Pugliese F, Williams MC, Stirrup J, Padley S, Taylor A, Davies LC, Bury R, Harden S. Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)--on behalf of the British Society of Cardiovascular Imaging (BSCI)/British Society of Cardiovascular CT (BSCCT). Br J Radiol 2016; 89:20150705. [PMID: 26916280 PMCID: PMC4985448 DOI: 10.1259/bjr.20150705] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Accurate and timely assessment of suspected acute aortic syndrome is crucial in this life-threatening condition. Imaging with CT plays a central role in the diagnosis to allow expedited management. Diagnosis can be made using locally available expertise with optimized scanning parameters, making full use of recent advances in CT technology. Each imaging centre must optimize their protocols to allow accurate diagnosis, to optimize radiation dose and in particular to reduce the risk of false-positive diagnosis that may simulate disease. This document outlines the principles for the acquisition of motion-free imaging of the aorta in this context.
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Affiliation(s)
- Varut Vardhanabhuti
- 1 Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Plymouth, UK.,2 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Edward Nicol
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | | | - Carl A Roobottom
- 1 Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Plymouth, UK.,5 Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Giles Roditi
- 6 Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Russell K Bull
- 8 Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Franchesca Pugliese
- 9 Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine & Barts Health NHS Trust, London, UK
| | - Michelle C Williams
- 10 University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Stirrup
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | - Simon Padley
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | - Andrew Taylor
- 11 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK
| | - L Ceri Davies
- 9 Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine & Barts Health NHS Trust, London, UK
| | - Roger Bury
- 12 Radiology Department, Blackpool Teaching Hospitals, Blackpool, UK
| | - Stephen Harden
- 13 Department of Cardiothoracic Radiology, University Hospital Southampton NHS Trust, Southampton, UK
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17
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Abbas A, Brown IW, Peebles CR, Harden SP, Shambrook JS. The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome. Br J Radiol 2014; 87:20140354. [PMID: 25083552 DOI: 10.1259/bjr.20140354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The term "acute aortic syndrome" (AAS) encompasses several non-traumatic life-threatening pathologies of the thoracic aorta presenting in patients with a similar clinical profile. These include aortic dissection, intramural haematoma and penetrating atherosclerotic ulcers. These different pathological entities can be indistinguishable on clinical grounds alone and may be confused with other causes of chest pain, including myocardial infarction. Multidetector-row CT (MDCT) is the current modality of choice for imaging AAS with a sensitivity and specificity approaching 100%. Early diagnosis and accurate radiological classification is associated with improved clinical outcomes in AAS. We review the characteristic radiological features of the different pathologies that encompass AAS and highlight the vital role of MDCT in determining the management of these life-threatening conditions.
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Affiliation(s)
- A Abbas
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
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