CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 9Prominent Ascending Aorta or
Aortic Arch

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig CA 9-1 Hypertensive heart disease. Marked
dilatation (arrows) of the ascending aorta
caused by increased aortic pressure.

4. • Fig CA 9-2 Atherosclerosis. Generalized
tortuosity and elongation of the ascending
aorta (open arrows) and descending aorta
(closed arrows).

5. • Fig CA 9-3 Aortic valvular stenosis. There is
prominence of the left ventricle with poststenotic
dilatation of the ascending aorta (arrowheads).
The aortic knob and descending aorta (arrows)
are normal.10

6. • Fig CA 9-4 Aortic insufficiency. Marked dilatation of the
ascending aorta (arrows), suggesting some underlying
aortic stenosis. The left ventricle is enlarged with
downward and lateral displacement of the cardiac
apex. Note that the cardiac shadow extends below the
dome of the left hemidiaphragm (small arrow).

7. • Fig CA 9-5 Syphilitic aortitis. Aneurysmal
dilatation of the ascending aorta with extensive
linear calcification of the wall (arrows). Some
calcification is also seen in the distal aortic arch.

8. • Fig CA 9-6 Pseudocoarctation of the aorta. (A) Frontal
view of the chest demonstrates two bulges (arrows)
producing a well-demarcated figure-3 sign in the region
of the aortic knob. The upper bulge (black arrow) is
higher than the normal aortic knob and simulates a
mediastinal mass. Because there is no hemodynamic
abnormality, the heart is normal in size, and there is no
rib notching. (B) In another patient, an aortogram
demonstrates extreme kinking of the descending aorta
(arrow) without an area of true coarctation.

9. • Fig CA 9-7 Patent ductus arteriosus. A convex
bulge (arrows) on the left side of the superior
mediastinum represents dilatation of the
aortic end of the ductus (“ductus bump”).

10. • Fig CA 9-8 Corrected transposition with
ventricular septal defect. (A) There is fullness
of the upper left border of the heart (arrows).
Because of the left-to-right ventricular shunt,
the pulmonary vasculature is engorged. (B) A
film from an angiocardiogram demonstrates
the inverted aorta and right ventricular
outflow tract (arrows).6

11. • Fig CA 9-9 Marfan's syndrome. Arteriogram
shows enormous dilatation of the aneurysmal
ascending aorta.