Imaging examination about aorta and it's disease

1. Anatomi, Topografi dan Modalitas Pencitraan
AORTA

2. ANATOMY

3. NORMAL ANATOMY OF THORACIC AORTA

5. BRANCHES
OF AORTIC
ARCH

6. Aortic Arc
Types

7. BRANCHES OF
THORACAL
AORTA

8. STANDARD ANATOMIC
LANDMARKS FOR REPORTING
AORTIC DIAMETER
1, Aortic sinuses of Valsalva
2, Sinotubular junction
3, Mid ascending aorta (midpoint in length between
No. 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
No. 6 and 8)
8, Aorta at diaphragm
9, Abdominal aorta at the coeliac axis origin.
Hiratzka et al. Circulation. 2010;121:e266-e369.)

9. NORMAL THORACIC AORTIC
DIAMETER

12. TOPOGRAPHY

13. BONE AND
ABDOMINAL
AORTIC
BRANCHES

14. MSCT

15.  Axial
 Coronal
 Sagital
Volume Rendering
MSCT VIEW OF AORTA

16. Point of View
CT Angio
AXIAL PLANE CORONAL PLANE
SAGITAL PLANE VOLUME RENDRING

17. AORTIC DISECTION

18. CLASIFICATION OF AORTIC DISECTION

20. Circulation. 1999;99:1331-1336

22. Characterized by :
1. True and false lumen
2. Intimal tear/ Entry site  communication between L.
3. Intimal Flap
CLASSIC DISSECTION

23. • Short Axis cleavage of the aortic media by dissecting column of
blood.
Classic Aortic Dissection
• Intimal flap consists of:
- intima
- media (inner 2/3)

24. • Long axis cleavage of the aortic media by dissecting column of
blood.
Classic Aortic Dissection
• Entry site
• Re Entry
• Intimal flap consists of:
- intima
- media (inner 2/3)

25. CTA MARKER – FALSE LUMEN
CLASSIC DISSECTION
AXIAL VIEW
• Beak Sign
• Cob Web Sign
• Wrap Sign usually in the Aortic Arch.
SAGITAL / CORONAL VIEW
• Must often is larger than true lumen .
• Less dencity than true lumen except entry site large
with expose reentry

31. IMH

32. IMH

34. PAU

35. PAU

37. Class 4 lesion : PAU

38. PAU

39. PAU

41. BRANCH-VESSEL COMPROMISE
Static Obstruction
Dynamic Obstruction
Williams DM et al. Radiology 1997;203:37-44
JVIR 1997;8:605-625

42. DYNAMIC OBSTRUCTION

43. STATIC OBSTRUCTION

45. AORTIC ANEURYM
I. Location
 TAA
 AAA
 TAAA
II Type
 Fusiform
 Saccular
II Diameter
IV NecK
V Iliac Arteries Tortuousity

46. FUSIFORM SACCULAR

47. SACCULAR ANEURYSM
• Still in controvesial
• Lobulated contour
• Rapid expansion or Development
and adjacent mass
• Stranding
• Fluid in unusual location
→ Highly suspicious for an infected
aneurysm
→ contraindication ? / stent-graft
placement with appropriate
antibiotic coverage
Macedo TA et al. Radiology 2004;231(1):250

48. AORTIC INFECTION
1,TB
2. Mycotic
3. Vasculitis

49. TUBERCULOUS MYCOTIC ANEURYSM
• Once symptomatic TBAA is identified,
treatment must not be delayed.
• The size of the aneurysm does not appear to
influence the need for treatment
• Aneurysms as small as 1.0-cm in diameter may
rupture
Long et al. Chest 1999;115(2):523

51. 38/F
40-day 50-day
Tuberculous Aneurysm

52. MYCOTIC ANEURYSM

53. Vasculitis

54. Vasculitis

55. Aortic Disection
Aortic Aneurysm
TEVAR OR EVAR REQUISITE

56. NECK / LANDING ZONE
PROXIMAL TO THE ANEURYSM
Morphology suitable for endovascular repair, including:
1.with a length of at least 15 mm,
2.with a diameter measured outer wall to outer wall of no
greater than 28 mm and no less than18 mm,
3.with an angle less than 60 degrees relative to the long
axis of the aneurysm,
4.with an angle less than 45 degrees relative to the axis of
the suprarenal aorta.

57. NECK / LANDING ZONE MEASUREMENTS

59. TAA
• Untreated TAA likely to expand over time and
rupture
• Coady et al. rupture in descending thoracic
aortic aneurysm 7 cm or greater, and they
recommended surgical repair when aneurysms
reach a diameter of 6.5cm
Coady MA, Cardiol Clin 1999;17(4):827

60. DIAMETER

62. CTA AXIAL LEVEL- AORTA

91. RUPTURE AAA
Primary Sign
1. Periaortic Stranding
2. Retroperitoneal Haematoma
ex Perirenal Compartment
3. Extravasation of Contras

92. RUPTURE AAA

93. A
RUPTURE AORTA

94. RUPTURE AAA

95. Rupture AAA

96. IMPENDING RUPTURE AAA
Secondary Sign (Impending)
1. High-attenuating crescent
2. Focal discontinuity of intimal calcification
3. Tangential calcium
4. Draped aorta

97. Imp.Rupture AAA

98. Imp. Rupture AAA

99. Imp. Rupture AAA

100. Impending Rupture AAA

101. Impending Rupture AAA

102. Rupture AAA

103. Impending Rupture AAA

104. Conclusion
MSCT of the Aorta is currently the imaging technique of choice
for evaluating patients with aortic diseases

105. THORACIC AORTIC

107. 1

109. 1

129. Rupture AAA
Primary Sign
1. Periaortic Stranding
2. Retroperitoneal Haematoma
ex Perirenal Compartment
3. Extravasation of Contras

130. Rupture AAA

131. Rupture AAA

133. Impending Rupture AAA
Secondary Sign (Impending)
1. High-attenuating crescent
2. Focal discontinuity of intimal calcification
3. Tangential calcium
4. Draped aorta

134. Rupture AAA

135. Rupture AAA

136. Rupture AAA

137. Rupture AAA

138. Rupture AAA

139. Rupture AAA

140. Rupture AAA

141. 1. Caput Humeri Dex., 2.Oesophagus, 3.Trachea , 4.v. Subclavia Sin. 5.Spina
Scapula ,6.Columna Scapula .

142. 1.Pulmo Dex, 2.Costa,3.Oesophagus ,4.Trachea,5.V.bracheocephalica
Sin.,6.a.Carotis Com. Sin,7.v.Axillaris sin.,8.Pulmo Sin., 9. Prosesus Transversus
,10.Scapula.

143. 1.Trachea,2Costa, 3.a.Bracheocephalica dex,4.v.Bracheocephalica Sin.,5.m.Pectoralis
Major., 6.m.Pectoralis Minor, 7.a.Carotis Comm.Sin.,8 a.Subclavia Sin. 9,
Oesophagus,10.Scapula.

144. 1.Pulmo dex,2.Costa ,3.Trachea,4.v.Bracheocephalica Sin,5.a. Bracheocephalica
,6.a.Carotis Comm. Sin.7.a. Subclavia Sin,8.Scapula,9.Oesophagus,10.Prosesus
Spinosus.