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Image of Thoracic Aortic Disease

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Image of Thoracic Aortic Disease

Image of Thoracic Aortic Disease
Reference:
2010 Guidelines on Thoracic Aortic Disease
Circulation. 2010;121:e266-e369

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    Image of Thoracic Aortic Disease Image of Thoracic Aortic Disease Presentation Transcript

    • Image of Thoracic Aortic Disease2010 Guidelines on Thoracic Aortic DiseaseCirculation. 2010;121:e266-e369.
    • Precontrast imagedemonstrates a highattenuation aortic hematomaindicating an acute aorticevent.Images obtained with contrastdemonstrate the contrast-filled aortic lumen and thehematoma as a relativelylower attenuation band.
    • Traumatic aortic rupture Traumatic injury with pseudoaneurysm (T) in the proximal descending thoracic aorta, numerous bilateral rib fractures, and small bilateral pleural effusions, with no significant mediastinal hematoma.
    • Mimic of aortic dissection createdby motion of the aortic rootImage at the level of the rightpulmonary artery demonstrates anormal descending thoracic aorta andpseudodissection of the ascendingaorta due to motion artifact thatoccurs on non–ECG gated CT (arrow).Image at the aortic root shows adouble contour to the aortic root thatmay simulate a dissection flap (arrow).
    • Left brachiocephalic vein mimics anintramural hematomaAxial CT image demonstrates a low attenuation crescentof material anterior to the innominate artery.
    • Normal anatomy of thoraco-abdominal aortawith standard anatomic landmarks forreporting aortic diameter as illustrated on CT1. Aortic sinuses of Valsalva2. Sinotubular junction3. Mid ascending aorta (midpoint in length between Nos. 2 and 4)4. Proximal aortic arch (aorta at the origin of the innominate artery)5. Mid aortic arch (between left common carotid and subclavian arteries)6. Proximal descending thoracic aorta (begins at the isthmus, approximately 2 cm distal to left subclavian artery)7. Mid descending aorta (midpoint in length between Nos. 6 and 8)8. Aorta at diaphragm (2 cm above the celiac axis origin)9. Abdominal aorta at the celiac axis origin
    • Arch aneurysm withdissection flapArch dissection, 2-D viewArch dissection (arrow) withcolor-flow Dopplermargination.
    • Artifact mimicking dissection.Top left, 2-D view.Top right, Color-flow Dopplerwithout margination.Bottom, Artifact not seen inthis view.
    • Takayasu arteritisNote narrowing of thearterial lumen andcircumferential soft tissuethickening of the walls ofthe great vessels andthoracic and abdominalaorta.Panel A, Image through thegreat vessels withnarrowing of the leftcommon carotid and leftsubclavian arteries.Panel B, Mid descendingthoracic aorta (arrowheads).Panel C, Aorta just abovethe diaphragm(arrowheads).Panel D, Infrarenal aorta.
    • Classes of intimal tearsI. Classic dissection with intimaltear and double lumenseparated by septum.II. Intramural hematoma. Nointimal tear or septum is imagedbut is usually found at surgery orautopsy. DeBakey Types II andIIIa are common extent of thislesion.III. Intimal tear without medialhematoma (limited dissection)and eccentric aortic wall bulge.Rare and difficult to detect byTEE or CT.IV. Penetrating atheroscleroticulcer usually to the adventitiawith localized hematoma orsaccular aneurysm. Maypropagate to Class I dissection,particularly when involvingascending aorta or aortic arch.V. Iatrogenic (catheterangiography or intervention)/traumatic (deceleration)dissection.
    • Type A aortic dissection fromthe cranial to caudal directionAlthough the flap appears todisappear in the infrarenal, it isactually compressed againstthe anterior wall of the aorta inPanel G (arrowheads) and it isclearly present caudally in thecommon iliac arteries in PanelH. Hemopericardium (asterisk)is visible in Panel D. Bowel wallthickening (arrowheads)indicates ischemia in Panel I.
    • Type A Aortic dissectionwith thrombosed falselumen and left renal arteryinvolvementDemonstrates markednarrowing of the true lumen,patent right renal arteryarising from the true lumen(bottom left, arrow), andnarrow left renal arterycompressed by thrombus inthe false lumen, withsecondary decreasedenhancement of the leftkidney compared with theright kidney. *Thrombus infalse lumen.
    • Aortic dissection classification: DeBakey and Stanford Classifications
    • Type B aortic dissection with mediastinal hematoma and pleural blood.Ruptured Type B aortic dissection with mediastinal hematoma (*) and pleuralblood. Left, Flap arises in the proximal descending thoracic aorta, with faintcontrast-enhanced blood adjacent to the site of rupture outside the confines ofthe aortic wall (arrow).
    • Intramural hematomademonstrated as a low-attenuation band of hematoma(arrows) in the aortic wall onCT images.
    • Penetrating atherosclerotic ulcer of the proximal descending thoracic aorta.Axial CT images at the level of the aortopulmonary window (left) and at the level ofthe left pulmonary artery (right) demonstrate a small penetrating ulcer (long arrow,U) that extends beyond the expected confines of the aortic lumen with adjacentintramural hematoma both at the level of the ulcer itself and that extends a fewcentimeters caudally in the wall of the descending thoracic aorta (short arrows).
    • Descending aneurysmclassification.Descending aneurysms areclassified as involvingthirds of the descendingthoracic aorta and variouscombinations. A involvesthe proximal third, B themiddle third, and C as thedistal third.Thoracoabdominalaneurysms are classifiedaccording to the Crawfordclassification: Type Iextends from proximal tothe 6th rib and extendsdown to the renal arteries.Type II extends fromproximal to the 6th rib and extends to below the renal arteries. Type III extends fromdistal to the 6th rib but from above the diaphragm into the abdominal aorta. Type IVextends from below the diaphragm and involves the entire visceral aortic segmentand most of the abdominal aorta. Juxtarenal and supraenal aneurysms are excluded.
    • Ultrasound image of aortic atheroma
    • Porcelain aorta.Top left and right, PA andlateral CXR show an anteriormediastinal mass withcurvilinear calcifications mostlikely representing the wall ofan ascending aortic aneurysm.Bottom left, CT scan slice atthe level of the rightpulmonary artery confirms a10-cm aneurysm of theascending aorta with densemural calcifications. Bottomright, A maximum intensityprojection in the obliquesagittal plane betterdemonstrates the fusiformaneurysm beginning at thesinotubular ridge andextending into the aortic arch.Dense mural calcificationextends into the proximaldescending aorta.