Radiology

1. M.kurtanidze
IMAGING OF THE ASCENDING AORTA, AND
DESCENDING THORACIC AORTA. THEIR MAJOR
BRANCHES AND THE STRUCTURES THEY
SUPPLY.IMAGING OF THE SUBCLAVIAN ARTERIES.

2. The aorta is the largest artery in the body, initially being an inch wide
in diameter. It receives the cardiac output from the left ventricle and
supplies the body with oxygenated blood via the systemic circulation.
The aorta can be divided into four sections: the ascending aorta,
the aortic arch, the thoracic (descending) aorta and the abdominal
aorta.
Branches
The left and right aortic sinuses are dilations in the ascending aorta,
located at the level of the aortic valve. They give rise to the left and
right coronary arteries that supply the myocardium.
The imaging options available for assessment of the
thoracic aorta include plain radiography, transthoracic
echocardiography (TTE), transoesophageal
echocardiography (TOE), multidetector CT, MRI and
invasive catheter angiography.

3. Ascending Aorta
The ascending aorta arises from the aortic orifice from the left ventricle
and ascends to become the aortic arch. travels with the pulmonary
trunk in the pericardial sheath.

5. In adults, an ascending aortic diameter
greater than 4 cm is considered to
indicate dilatation

6. Aortic Arch
The aortic arch is a continuation of the ascending aorta and begins at
the level of the second sternocostal joint. It arches superiorly,
posteriorly and to the left before moving inferiorly.
The aortic arch ends at the level of the T4 vertebra. The arch is still
connected to the pulmonary trunk by the ligamentum
arteriosum (remnant of the foetal ductus arteriosus).

7. Branches
There are three major branches arising from the aortic arch. Proximal to distal:
Brachiocephalic trunk: The first and largest branch that ascends laterally to split into the right common carotid and
right subclavian arteries. These arteries supply the right side of the head and neck, and the right upper limb.
Left common carotid artery: Supplies the left side of the head and neck.
Left subclavian artery: Supplies the left upper limb.

10. Fetal heart aortic arch

11. The brachiocephalic trunk, also called the brachiocephalic or innominate artery, is the second branch to
arise from the aorta. It courses upwards from the aortic arch through the superior mediastinum, until it
reaches the right sternoclavicular joint, where it divides into its final branches.
The brachiocephalic trunk gives off the right subclavian artery, supplying the right upper limb; and the
right common carotid artery, supplying the right side of the brain, head and neck.

12. magnetic resonance angiography

13. The arch position may be altered:
-right sided aortic arch
-double aortic arch

15. Thoracic Aorta
The thoracic (descending) aorta spans from the level of T4 to T12.
Continuing from the aortic arch, it initially begins to the left of the
vertebral column but approaches the midline as it descends. It leaves
the thorax via the aortic hiatus in the diaphragm, and becomes the
abdominal aorta.
Branches
In descending order:
Bronchial arteries: Paired visceral branches arising laterally to supply bronchial and peribronchial tissue and visceral pleura.
However, most commonly, only the paired left bronchial artery arises directly from the aorta whilst the right branches off
usually from the third posterior intercostal artery.
Mediastinal arteries: Small arteries that supply the lymph glands and loose areolar tissue in the posterior mediastinum.
Oesophageal arteries: Unpaired visceral branches arising anteriorly to supply the oesophagus.
Pericardial arteries: Small unpaired arteries that arise anteriorly to supply the dorsal portion of the pericardium.
Superior phrenic arteries: Paired parietal branches that supply the superior portion of the diaphragm.
Intercostal and subcostal arteries: Small paired arteries that branch off throughout the length of the posterior thoracic aorta.
The 9 pairs of intercostal arteries supply the intercostal spaces, with the exception of the first and second (they are supplied
by a branch from the subclavian artery). The subcostal arteries supply the flat abdominal wall muscles.

17. Origin of orthotopic bronchial arteries. Axial (a) and sagital (b) CECT view of an
orthotopic bronchial artery (black arrows) originating from the descending
thoracic aorta (DA) at the T5–T6 vertebral plane, near the carinal level

18. Dilated bronchial artery
Normal bronchial arteries are very thin (< 1.5 mm). The causes of
bronchial artery dilatation are variable and include congenital and
acquired diseases

19. Aneurysm of bronchial artery

20. Ruptured intercostal artery aneurysm

21. Descending Thoracic Aorta Remodeling after Multilayer Stent
Release
A 68-year-old man with a 18-mm blister-like aneurysm of the
descending thoracic aorta

22. Techniques of imaging of the aorta and its first order
branches by endoscopic ultrasound
The origin of right coronary artery is seen from the anterior
sinus

23. Clockwise rotation from along the left lateral wall of
the esophagus shows the left subclavian artery. The
left brachiocephalic vein crosses anterior to the artery

27. Ruptured descending aortic aneurysm. The CT
angiogram demonstrates the peri-aortic
haematoma and left haemothorax characteristic of
rupture in this man who presented with acute chest
pain. The peri-aortic tissues contained the leak long
enough for him to undergo successful endovascular
stenting.

28. This man was found to have an incidental
large saccular aneurysm arising from the
proximal descending aorta. He had a
history of significant trauma in the past so
this was regarded as a chronic post-
traumatic pseudo-aneurysm.

29. Traumatic aortic rupture stented CT. CT angiogram
72 h after endograft placement. This demonstrates
successful repair of the ruptured aorta