Acute aortic syndrome: CT findings

Letter REPLY Re: “Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization”

“…We agree with the comment of Canyigit et al [1] that this kind of pathology is extremely rare and that penetrating atherosclerotic ulcer is the most likely underlying mechanism of its formation [1]. Contrast-enhanced multidetector computed tomography (MDCT) has become the technique of choice to evaluate aortic disease for its specificity, sensibility, and availability [2].…”

Imaging the posterior mediastinum: a multimodality approach

“…The most relevant finding predictive of rupture is the maximum diameter of the aneurysm; a descending aorta aneurysm greater than 6-6.5 cm and enlarging more than 10-12 mm/year is a candidate for surgery (32,33). Smaller aneurysms should be monitored annually, either by CT or MRI (32). Patients with renal impairment may benefit from sequences that do not require contrast administration, such as balanced steady-state free precession magnetic resonance angiography (33).…”

“…A thoracic aortic aneurysm is considered "unstable" when it is rapidly enlarging or shows signs of rupture or imminent rupture, such as a high-attenuation crescent within the aortic wall on unenhanced CT images, reflecting intramural hematoma. In addition, other findings of a rupture include focal discontinuity of intimal calcifications, eccentric shape of the aorta, and a "draped" aorta, which is defined as an indistinct margin of the posterior aortic wall from the adjacent vertebral body (32). Rupture of a descending aortic aneurysm usually occurs into the mediastinum and the left pleural space, producing periaortic soft-tissue hematoma, hemothorax, pleural or pericardial effusion, or even a contrast blush of active extravasation at the site of rupture (32,33).…”

“…In addition, other findings of a rupture include focal discontinuity of intimal calcifications, eccentric shape of the aorta, and a "draped" aorta, which is defined as an indistinct margin of the posterior aortic wall from the adjacent vertebral body (32). Rupture of a descending aortic aneurysm usually occurs into the mediastinum and the left pleural space, producing periaortic soft-tissue hematoma, hemothorax, pleural or pericardial effusion, or even a contrast blush of active extravasation at the site of rupture (32,33). The most relevant finding predictive of rupture is the maximum diameter of the aneurysm; a descending aorta aneurysm greater than 6-6.5 cm and enlarging more than 10-12 mm/year is a candidate for surgery (32,33).…”

“…Rupture of a descending aortic aneurysm usually occurs into the mediastinum and the left pleural space, producing periaortic soft-tissue hematoma, hemothorax, pleural or pericardial effusion, or even a contrast blush of active extravasation at the site of rupture (32,33). The most relevant finding predictive of rupture is the maximum diameter of the aneurysm; a descending aorta aneurysm greater than 6-6.5 cm and enlarging more than 10-12 mm/year is a candidate for surgery (32,33). Smaller aneurysms should be monitored annually, either by CT or MRI (32).…”