radiological anatomy of retroperitoneum powerpointDactarAdhikari
brief and concise on radiological anatomy of retroperitoneum
includes topic like pararenal space,perirenal space,fascial plane,retroperitoneum hematoma and sign of mass origin
radiological anatomy of retroperitoneum powerpointDactarAdhikari
brief and concise on radiological anatomy of retroperitoneum
includes topic like pararenal space,perirenal space,fascial plane,retroperitoneum hematoma and sign of mass origin
Describe types of bowel wall thickening on enhanced CT scan and the diagnostic signs to differentiate inflammatory , neoplastic , ischemic and other causes of bowel wall thickening .
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Describe types of bowel wall thickening on enhanced CT scan and the diagnostic signs to differentiate inflammatory , neoplastic , ischemic and other causes of bowel wall thickening .
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
ANEURYSMS , TYPES AND THERE MANAGEMENT.pptxBipul Thakur
Discussion about different types of Aneurysm, details about Abdominal aorta aneurysm and brief discussion about some important peripheral aneurysms.
Includes approach to different forms of Abdominal aortic aneurysm, its management and complications related to the surgery.
one of most important topic of vascular surgery , i couldn't find this much in slideshare so , i made a slide and uploaded it . Hope you will enjoy reading :)
introduction,
definition
types
causes etc
Management
Routine ultrasound procedures. These procedures will monitor the size and rate of growth of the aneurysm every 6 months to 12 months as part of a "watchful waiting" approach for smaller aneurysms.
Controlling or modifying risk factors. Steps such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm.
Medication. Medication can control factors such as hyperlipidemia (elevated levels of fats and cholesterol in the blood) and/or high blood pressure.
Surgery
Aneurysm open repair. An incision is made to directly visualize and repair the aneurysm. A cylinder-like tube called a graft may be used to repair the aneurysm. Grafts are made of various materials, such as Dacron The open repair is considered the surgical standard for an abdominal aortic aneurysm repair
Endovascular aneurysm repair (EVAR). EVAR is a procedure that requires only small incisions in the groin along with the use of X-ray guidance and specially-designed instruments to repair the aneurysm. With the use of special endovascular instruments and X-ray images for guidance, a stent-graft is inserted via the femoral artery and advanced up into the aorta to the site of the aneurysm.
Most common type of birth defect
Defect in structure or function of the heart and great vessels
1 in 1000 live births
The incidence is higher in stillborns (3-4%), spontaneous abortuses (10-25%), and premature infants
About 1 in 4 babies born with a heart defect has a critical heart disease
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Anatomy
• Aorta begins in the aortic root as ascending aorta.
• The aortic arch begins at the innominate artery and ends at the
ligamentum arteriosum. Its most distal aspect, which is often slightly
narrowed, is termed the “aortic isthmus.”In some cases small
diverticulum called ductus diverticulum.
• The descending aorta begins at the ligamentum. Its proximal portion
may appear slightly dilated and has been termed the “aortic spindle.”
4. Branches of Aorta
Descending thoracic aorta
• Visceral branches:
Pericardial branches,
Bronchial arteries (one on
the right and two on the
left side), Mediastinal
branches, Phrenic branches.
• Parietal branches:
Intercostal arteries,
subcostal arteries
Abdominal aorta
Ventral: Unpaired-coeliac axis,
superior mesenteric,
inferior mesenteric
Lateral: Paired-inferior phrenic,
Middle suprarenal, Renal,
Testicular or ovarian
Dorsal: Lumbar (5-Paired), Median
sacral (Unpaired)
Terminal: Common iliac (Paired).
5. Variant Anatomy
• This normal branching pattern is seen in about 70% of individuals.
• Left CCA and Brachiocephalic trunk have common origin -20–30% of
individuals, most common => Bovine arch.
• In about 5% of cases, the left vertebral artery arises as a separate branch
directly from the aorta, between the left common carotid artery and the left
subclavian artery.
• Common origin of both CCA.
• Paired brachiocephalic trunk.
6. Variant anatomy – Abdominal Aorta
• left hepatic artery originating from
the left gastric artery (25%).
• The “replaced origin” of the right
hepatic artery from the superior
mesenteric artery (SMA) in 10% of
the
• The common hepatic artery may
take origin directly from the SMA
or the aorta
• The celiac axis and SMA may have a
common origin.
7. • Aneurysm
• A localized abnormal dilatation of
an artery, vein, or the heart.
• Aortic aneurysm
• thoracic
• abdominal
• thoracoabdominal
11. Atherosclerotic aneurysm
• Cause - Atherosclerosis of the aorta
• In elderly
• Location
• Descending aorta distal to Left
SCA.
• Infrarenal aorta
• Thoracoabdominal
• Fusiform- 80%, saccular-20%
12. Mycotic aneurysm
• Infectious break in the wall of an artery with formation of a blind,
saccular outpouching that is contiguous with the arterial lumen.
• Predisposing factors
• IV drug abuse
• Bacterial endocarditis (12%)
• Immunocompromise (malignancy, steroids, chemo, DM, etc.)
• Infected prosthetic valves or sternal wires
13. • Organisms
• S. aureus (53%)
• Salmonella (33-50%)
• Streptococcus
• Mycobacterium ( contiguous spread from spine/lymph node)
• The most common cause of an infected aneurysm is direct deposition of
circulating bacteria in a diseased, atherosclerotic, or traumatized aortic
intima, after which organisms penetrate the aortic wall through
breeches in intimal integrity to cause microbial arteritis.
14. • Site
Ascending aorta > visceral artery > intracranial artery >
upper/lower extremity artery.
• Poor prognosis due to quick expansion- rupture.
15. Findings in mycotic aneurysm
1. Unusual location (non infrarenal)
2. Saccular aneurysm
3. Irregular contour
4. Lack of calcification
5. Rapid enlargement
6. Signs of infection
• Perianeurysmal air
• Perianeurysmal fluid collection with enhancing wall
• Enlarged perianeursymal lymph nodes
• Osteomyelitis of adjacent vertebra
16. Images obtained in a 73-year-old man with infected infrarenal aortic aneurysm associated with
osteomyelitis and psoas muscle abscess. (a) Transverse contrast-enhanced CT scan shows an
infrarenal aortic aneurysm (*) measuring 11 x 6 cm in diameter associated with a left psoas muscle
abscess (arrowhead) and vertebral body destruction (arrow). (b) Sagittal T1-weighted MR image
shows abnormal signal intensity (arrow) in the bone marrow of the vertebral body.
17. Abdominal aortic aneurysm
• Abdominal aortic aneurysms (AAAs) are segmental
dilatations of the aortic wall that cause the vessel to be
larger than 1.5 times its normal diameter or that cause the
distal aorta to exceed 3 cm.
• Prevalence:
• Increases with age
• Greater with atherosclerotic disease
• Male predominance
• Whites: Blacks = 3:1
18. •Risk factors:
• male
• age >75 years
• white race
• prior vascular disease
• hypertension
• cigarette smoking
• family history
• hypercholesterolemia
19. Associated with:
• occlusion of inferior mesenteric artery (80%)
• occlusion of lumbar arteries (78%)
• stenosis of renal artery (22-30%)
• stenosis / occlusion of celiac trunk / SMA (22%)
• isolated iliac + femoral artery aneurysm (16%)
• common iliac (89%), internal iliac (10%), external iliac (1%)
• visceral + renal artery aneurysm (2%)
21. Anatomical classification
• In relation to the renal arteries.
• Suprarenal
• Juxtarenal (within 1.5 cm of renal artery origin)
• Pararenal (involving one or both renal arteries)
• Infrarenal
• ~90-95% of AAAs -infrarenal
• Extension above renal arteries
• rare
• Extension to common iliac arteries
• fairly common (66-70%).
22. Progression of AAA
• Over time, ~80% enlarge.
• Most enlarge slowly.
• Larger- faster.
• smaller-slower
• >=5cm 4-8mm/year
• 4-5cm 3-7mm/year
• <4cm 2-5mm/year
23. Imaging modalities
Plain X-ray:
• mural calcification (75-86%)
• US initial screening
• If the aneurysm is approaching 5 cm or more or if rapid enlargement
is seen on serial US images
• CT and CTA/ MR and MRA
• Angiography
24. Curvilinear calcification (arrowheads) is consistent
with a significant size calcified abdominal aortic
aneurysm.
The lateral view clearly shows calcification of
both walls. Abdominal aortic aneurysm can be
diagnosed with certainty- egg shell
calcification.
25. USG
• >98% accuracy in size
measurement
• screening examination of choice as
a result of its relative availability,
speed, low cost and no radiation.
• Problems with
• obese pt
• distended bowel with gas
• proximal iliac arteries
27. • US findings of rupture
• Partially encapsulated hematomas - a hypoechoic or anechoic paraaortic
space-occupying lesion.
• Color Doppler-site of leak or extravasation
29. CT-contrast-enhanced
• Accurately demonstrates dilation of the aorta
• Extent of aneurysm
• Degree of calcification, presence of mural thrombus
• Major branch vessels proximally and distally-- helps in determining the
appropriate intervention (surgical or endovascular repair).
• Assessment of other abdominal organs possible.
• CTA -multiplanar assessment of the aneurysm and associated relevant
vessels (visceral arteries, iliac and femoral arteries).
• Complications
30. MRI
• MRI and MRA good alternatives
in
• impaired renal function and
• allergy to ICM
31. Angiography
• Often ordered for preoperative evaluation in patients with
manifestations of atherosclerotic vascular disease such as renal
artery stenosis or peripheral vascular disease.
• The role of angiography is in planning surgical or endovascular
repair.
• Largely replaced by CTA or MRA.
32. Angiography findings
• focally widened aortic lumen
>3 cm
• mural clot (80%)
• apparent normal size of
lumen secondary to mural
thrombus (11%)
• slow antegrade flow of
contrast medium
33. Lateral aortogram in a patient with severe mid back pain and lumbar spine images
which demonstrated anterior erosion of the lower thoracic vertebral bodies. The
angiogram demonstrates that this has been caused by a pulsatile thoracoabdominal
aortic aneurysm.
35. Rupture
•Sites
• into retroperitoneum: commonly on left
• into GI tract: massive GI hemorrhage
• into IVC: rapid cardiac decompensation
• Symptoms of rupture
• sudden severe abdominal pain ± radiating into back
• fainting, syncope, hypotension
• Prognosis:64-94% die before reaching hospital
36. High risk for rupture of AAA
• >5cm
• Rapid growth ( >5mm per 6
months) or a diameter of
7cm
• Mycotic aneurysm
Signs of AAA rupture
• Primary signs
• Periaortic stranding
• Retroperitoneal hematoma
• Extravasation of IV contrast
• Secondary signs
• High attenuating crescent sign
• Focal discontinuity of intimal
calcification
• Tangential calcium sign
• Draped aorta sign
• Thrombus fissuration
37. Foccal discontinuity of
intimal calcification
Tangential calcium sign:
Intimal calcification points
away from the aneurysm
and
there is retroperitoneal
leakage.
38. LEFT: Subtle periaortic stranding, MIDDLE: Hemorrhage into posterior pararenal and
perirenal compartment, RIGHT: Extravasation of iv. contrast
39. CECT-draped aorta sign: Posterior wall of the aneurysm is not seen and the
aneurysm extends around the vertebral body and on left paravertebral region
An important imaging feature that
may be seen in a contained
rupture of an abdominal aortic
aneurysm is the draped aorta
sign. This sign is considered
present when the posterior wall
of the aorta either is not
identifiable as distinct from
adjacent structures or when it
closely follows the contour of
adjacent vertebral bodies.
41. Ruptured aneurysm
• anterior displacement of
kidney
• extravasation of contrast
material
• fluid collection / hematoma
within posterior pararenal +
perirenal spaces
• free intraperitoneal fluid
42. False positive CT dx of aneurysm rupture
• Asymmetric aneurysm thrombus
• Partial volume averaging of periaortic tissue at the level of
the aneurysm neck.
• Perianeurysmal fibrosis( in NECT)
• Unopacified 3rd and 4th portion of Duodenum.
• Retroperitoneal lymphadenopathy.
43. Pre-op assessment of AAA
• We should assess :
• Maximum diameter of the aneurysm
• Proximal and distal extent of aneurysm
• Assessment of iliac and renal arteries
• Perianeurysmal fibrosis
• Congenital variations:
• Accessory renal arteries
• Retroaortic course of left renal vein
• CT/CTA or MR/MRA is required for pre-op assessment.
• USG is not enough because:
• Perianeurysmal soft tissue can not be assessed
• Relation with renal arteries & congenital variations are difficult to assess
45. Open surgery- indications
(1) Any patient with a documented rupture or suspected
rupture;
(2) symptomatic or rapidly expanding aneurysm, regardless of
its size;
(3) aneurysms larger than 5 cm in diameter;
(4) complicated aneurysms with embolism, thrombosis, or
symptomatic occlusive disease; and
(5) atypical aneurysms (eg, dissecting, mycotic, saccular).
46. Endovascular aortic aneurysm repair (EVAR)
• EVAR has been shown to reduce blood loss, operative time, length of
hospital stay, mortality, and morbidity compared with open surgical
repair of infrarenal abdominal aortic aneurysms (AAAs).
47. Endovascular repair such as stent-graft
placement
gain access to the
lumen of the
abdominal aorta,
usually via small
incisions over the
femoral vessels.
Endograft is placed
within the lumen
of the AAA
extending distally
into the iliac
arteries.
serves as a bypass
and decreases the
pressure on the
aortic wall, leading
to a reduction in
AAA size over time
and a decrease in
the risk of aortic
rupture.
48.
49. Endoleaks.
• Persistent flow in an excluded aneurysmal sac after endovascular treatment
with stent graft.
• Type I: leak at graft attachment site
• Ia: proximal, Ib: distal and Ic: iliac occluder
• Type II: aneurysm sac filling branch vessel {M/C}
• IIa: single vessel, IIb: 2 or more vessels
• Type III: leaks through defect in graft
• IIIa junctional separation of modular component, IIIb fracture or holes
• Type IV: leak through the graft fabric as result of graft porosity
• Type V: continued expansion of aneursymal sac without demonstrable leak
on imaging (ENDOTENSION)
50. • Close follow-up is required
• CT scans performed at one, six, and 12 months, and then
yearly
51. Thoracic aortic aneurysm
• Aneurysmal dilatation of ascending, arch, or descending
thoracic aorta.
• Aneurysm - localized or diffuse dilatation of more than 50%
normal diameter of the aorta.
52. Anatomical classification
Type Cause
1.Aneurysm of sinus of Valsalva
2. Ascending aorta
3. Arch of aorta
4. Descending aorta
5. Aortic isthmus
1.Congenital, Syphilis
2. Atherosclerosis, Marfan syndrome, Ehlers- Danlos
syndrome, syphilis, mycotic aneurysm
3. Atherosclerotic
4. Atherosclerotic
5. Post traumatic aneurysm
53. • Descending aorta
>ascending aorta >Arch of
Aorta aneurysms
• Descending aortic thoracic
aneurysms may extend
distally to involve the
abdominal aorta and create
a thoracoabdominal aortic
aneurysm.
• Mean age 65 years
• M:F 3:1
• Clinical features
• Substernal/back/shoulder pain
• SVC syndrome ( venous
compression)
• Dysphagia (esophageal
compression)
• Stridor, dyspnea
( tracheobronchial)
• Hoarseness (recurrent laryngeal
nerve com)
55. CXR
• Many readily visible on CXR.
• Findings
• (1) widening of the
mediastinal silhouette,
• (2) enlargement of the
aortic knob
• (3) displacement of the
trachea/esophagus from
the midline.
56. TEE
–can be quickly performed at
bedside under sedation without
radiation or the injection of
contrast material.
–excellent at detecting pericardial
effusion and aortic regurgitation
–90% accuracy in imaging intimal
membranes for signs of aortic
dissection
• Disadvantage - poorly depicts
aneurysms below the diaphragm and
in the transverse aortic arch.
Atherosclerotic and
enlarged descending
aorta with eccentric
thickening of the wall.
57. CT/CTA
• primary diagnostic test of choice in most institutions
• reliable test for diagnosing aneurysm and dissection
• effective to define maximum diameter
• To monitor diameter over time.
• Findings:
• increase in aortic diameter
• outward displacement of calcium of the aortic wall.
58.
59.
60. MR/MRA
• Alternative of CT/CTA specially in pt with
• impaired renal function and
• allergy to ICM
• Velocity-encoded cine MRI
• measurement of the differential flow velocity in the true and
false channels
• to quantify the volume of concomitant aortic regurgitation in
patients with aortoannular abnormalities.
61. Aortography
• The criterion standard until late
• But rarely used with the advent
of helical CT/MRI/MRA/TEE
• Still a modality for
• pre-op evaluation of
thoracic aortic aneurysms
• for precise definition of the
anatomy of the aneurysm
and great vessels
Ascending aortogram showing
ascending aortic aneurysm.
62. Thoraco- Abdominal Aneurysms
• Type I and Type II TAAAs involve the entire thoracic aorta extending
distally to or beyond the renal arteries, respectively.
• Type III TAAAs start below the T6 level and extend beyond the renal
arteries.
• Type IV TAAAs are the simplest form, starting at the level of the celiac
axis and extending distal into the infrarenal aorta or iliac arteries.
• Type VI: start below the T6 level and extend upto the renal arteries.
63.
64. Aortic Dissection
• Separation of the aortic
intima with tear in it
communicating with the
true lumen.
• True lumen-inside the intima
• False lumen-outside the
intima
Most dissections arise either
just distal to the aortic valve or
the aortic isthmus
65. Pathophysiology
• The essential feature of aortic dissection is a tear in the intimal layer,
followed by formation and propagation of a subintimal hematoma.
• The dissecting hematoma commonly occupies about half and
occasionally the entire circumference of the aorta. This produces a
false lumen or double-barreled aorta, which can reduce blood flow to
the major arteries arising from the aorta.
• Aortic dissection often occurs along the right lateral wall of ascending
aorta and descending thoracic aorta just below the ligamentum
arteriosum.
• The dissection usually propagates distally down the descending aorta
and into its major branches, but it also may propagate proximally.
67. C/F:-
• Predisposing factors
• Starts in fusiform aneurysms in
28 % cases
• Hypertension (60-90%)
• Marfan syndrome
• Ehlers- Danlos syndrome
• Trauma
• Catheterization
• Aortitis
1. Sudden onset of sharp, tearing,
intractable chest pain, may radiate to
back, esp. interscapular region
2. Previously hypertensive, now possible
shock (Signs of peripheral organ blood
flow hypoperfusion, including decreased
urine output, ischemia bowel, ischemia
pain of lower extremities, etc.)
3. Asymmetric peripheral pulse
4. Diastolic murmur or bruit of aortic
regurgitation
5. Pulmonary edema
6. Signs result from compression of
adjacent tissues
68. Imaging Findings
Chest X-ray:
o Mediastinal widening
o Displacement of
intimal calcifications
o Apical pleural cap
o Left pleural effusion
o Displacement of
endotracheal tube or
nasogastric tube
69. • CT
• Intimal flap
• Displacement of intimal
calcification
• Differential contrast
enhancement of true versus false
lumen
• MRI
• Intimal flap
• Slow flow or clot in false lumen
• TEE
• Intimal flap
Angiography
• Intimal flap
• Double lumen
• Compression of true lumen by
false channel
• Obstruction of branch vessels
70. True versus false channel
False lumen:
• anterior in the ascending aorta
• larger caliber than true lumen
• beak sign: acute angle with intimal
flap at corner
• intimal flap curved towards false
lumen
• thrombus is common
• cobwebs due to medial strands
• Slower flow in false channel on MR
True lumen:
• continues with the lumen
of nondissected segment
• Posterior and left lateral -
descending aorta
• smaller caliber
• intimal calcification
towards true lumen
71. TEE view of the descending thoracic aorta in the
horizontal plane. An aortic dissection is manifested by
the presence of a true lumen (TL), a false lumen (FL),
and a free-floating intimal flap (F). LA left atrium
72. Axial double-inversion-recovery MR images (TR/TE, 1875/18; inversion time, 150 msec) of 37-
year-old man with Marfan syndrome. Image shows classic aortic dissection with double-
channel aorta. True lumen (straight arrow) is smaller than false lumen (curved arrow). High-
velocity flow in true lumen causes signal void. Slower flow with higher signal can be seen in
false lumen.
73. 61-year-old man with chest pain and acute type A aortic dissection. Axial enhanced CT
scan of ascending aorta shows type A aortic dissection with intimomedial tear (arrows)
entering false lumen (F) from true lumen (T). DA = descending thoracic aorta, PA =
pulmonary artery.
74. CT scan obtained at one-quarter distance along length of dissected portion of aorta
shows descending aortic dissection flap (arrows) that is curved toward false lumen
(F). Beak sign (arrowheads) is present in false lumen. Note that false lumen area is
larger than true lumen area
75. CLASSIFICATION SYSTEMS FOR AORTIC DISSECTION
Site of dissection Classification system
Crawford DeBakey Stanford
Both ascending and
descending aorta
Proximal dissections Type I Type A
Ascending aorta and arch
only
Proximal dissections Type II Type A
Descending aorta only
(distal to left subclavian
artery)
Distal dissections Type III
IIIa—limited to thoracic
aorta
IIIb—extends to
abdominal aorta
Type B
76. Aortitis
Causes:
• Takayasu arteritis
• Rheumatic fever
• Reiter’s syndrome
• Syphilis
• Begins above sinotubular ridge
• Giant cell arteritis
• Ankylosing spondylitis
• Crosses sinotubular ridge and
dilates both root and ascending
aorta
Sinotubular Ridge-
The sinotubular ridge is the portion of the ascending
aorta just distal to the sinuses of Valsalva at the
junction with the tubular segment of the ascending
aorta.
77. Takayasu arteritis
• Granulomatous vasculitis of unknown etiology
• Commonly affects the thoracic and abdominal aorta
• causes intimal fibroproliferation of the aorta, great vessels,
pulmonary arteries, and renal arteries
• results in segmental stenosis, occlusion, dilatation, and aneurysm
formation in these vessels.
• Takayasu arteritis is the only form of aortitis that causes stenosis
and occlusion of the aorta.
78. • Pathophysiology:
• Not fully elucidated to date.
• begins as a nonspecific, cell-mediated inflammatory
process in the patient's first 2 decades of life and
progresses to the formation of fibrotic stenoses of the
aorta and its major branches.
79. Clinical Details:
• 15-40 years
• 8:1 females,
• Early and late phases.
• Presenting symptoms are Non-
specific –
• Fever,
• Arthralgia and
• weight loss.
• In pulseless phase- s/s of ischemia of
limb, renovascular hypertension.
• The early phase –
• inflammatory -prepulseless phase
• Present with constitutional sign and
symptoms with positive lab findings
(Increased ESR, positive C-reactive
protein).
• Radiological findings show only
thickened vessel wall on CT and MR.
• Angiography is usually negative.
• The late phase
• occlusive -pulseless phase.
• has thickening of media and adventitia.
• Angiographic findings show smooth long
segment stenosis and occlusions of the
proximal great vessels.
• A 5- to 20-year interval between two
phases.
80. Four types of late-phase
Takayasu arteritis • On the basis of the sites of
involvement
• Type I – aortic arch and its
branches
• Type II – thoraco-
abdominal aorta and its
major branches
• Type III - Combination of
type I and II
• Type IV – any portion of
the aorta with its branches
+ pulmonary artery.
• {source: Grainger}
82. • Advantages of CTA and MRA over
conventional angiography:
• large fields of view
• noninvasive nature
• intravenous rather than intra-
arterial contrast material
• increasing resolution of MDCT.
• Particularly useful in pediatric
groups who are poor
candidates for conventional
angiography.
• Advantages of MRI over CT
• Better soft-tissue contrast-
valuable in differentiating
active versus quiescent forms
of Takayasu disease.
• No use of ICM
83. Imaging Findings
• Angiography: The angiographic features occur late in the course
of the disease and include
oluminal irregularity
o vessel stenosis, occlusion, dilatation, or aneurysms in the aorta
or its primary branches.
• CTA and MRA- thickened wall of aorta with crescents and
indistinct outlines
• Associated aneurysms may be saccular or fusiform.
• USG/Doppler study in accessible vessels. Shows wall thickness and
stenosis.
84. Aortogram of a 15-year-old girl with Takayasu arteritis. Note large
aneurysms of descending aorta and dilatation of innominate artery
85. Coronal MRI of abdomen of 15-year-old girl with Takayasu arteritis. Note
thickening and tortuosity of abdominal aorta proximal to kidneys.
86. Intervention
• Corticosteroid- acute phase
• Bypass graft surgery is the procedure with the best long-
term patency rate
• Percutaneous angioplasty:
• C/I in acute phase.
• Best results with short-segment stenosis.
• Stents
87.
88. References
• Textbook of radiology and imaging-David Sutton
• CT and MRI of the whole body-John R. Haaga
• Fundamentals of diagnostic radiology-William E.Brant
• Https://Radiologykey.com//thoracicaortic-aneurysms
• Takayasu arteritis: imaging spectrum at multidetector CT
angiography; F P ZHU et al.; British Journal of Radiology; 2012.
• Acute Traumatic Aortic Injury: Imaging Evaluation and Management;
Scott D. Steenburg;RSNA; 2008:248; 3.
Editor's Notes
The arch may be subdivided into proximal (right brachiocephalic artery to left subclavian artery) and distal (left subclavian artery to attachment of the ligamentum arteriosum) segments. The distal arch, also referred to as the isthmus, may be narrower than the proximal descending aorta.
Measurement of the Aorta.
Ductus diverticulum consists of a convex focal bulge along the anterior undersurface of the isthmic region of the aortic arch (31). Although ductus diverticulum is commonly believed to be a remnant of the closed ductus arteriosus, it has been suggested that this entity may actually represent a remnant of the right dorsal aortic root
Infra renal aorta (a/w thoracic aneurysm in 29%)
Imp to timely diagnosis bcz of poor prognosis.
Non modifiable- Age, sex, race, family history.
This arteriogram was obtained in preparation of an endovascular repair of the aneurysm.
Hyperdense crescent sign is seen as a well-defined peripheral, high-density, crescent configuration within a thrombus where there is internal dissection of hemorrhage into the thrombus and ultimately reaching the aortic wall. It is a sign of acute or impending rupture.
primary factors that determine suitability for endovascular repair are diameter and length of the proximal neck of the aneurysm- short and wide neck – poor fitting of stent.
tortuosity of the aorta- poor fitting and
anatomy of the iliac arteries- long and large common iliac artery poor anchorage.
Endovascular options for branch incorporation include: Fenestrated branched devices for pararenal aneurysms, multibranched devices for thoracoabdominal aneurysms, and
iliac branch devices for aortoiliac aneurysms.
Fenestrated and branched stent-grafts allow incorporation of aortic side branches and preservation of end-organ perfusion while achieving aneurysm exclusion with a total endovascular approach
Main aim of imaging is to dx the aneurysm and find out the complication( dissection) as early as possible.
1. Obvious widening of mediastinum 2. Trachea deviation to right 3.Obvious cardiomegaly, interstitial pulmonary edema and engorged pulmonary vessel 4.No CP angle blunting
Atherosclerotic and enlarged descending aorta with eccentric thickening of the wall.
A diameter >4 cm - aneurysm.
A diameter >6 cm- usually an indication for surgery
Desc thoracic aorta thrombus
Pear shaped aorta with normal aortic arch - Marfan’s syndrome.