Acute Aortic Syndrome: Recent Trends in Imaging Assessment Using Computed Tomography Angiography

Kang, Eun Hae; Lee, Ki-Nam; Lee, Jongmin

doi:10.22468/cvia.2017.00108

Cited by 3 publications

(4 citation statements)

References 46 publications

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“…As far as the most accepted widespread criteria are represented by the maximum diameter and the expansion rate, there are other important imaging features that radiologists must be aware of, to promptly detect potentially life-threatening conditions ( Table 6 ). These features are considered by most authors as signs of impending rupture (SIR) and include, amongst others, (1) a hyper-attenuating crescent sign, (2) focal wall discontinuity of circumferential calcifications ( Figure 12 A), (3) aortic bulges or blebs, and (4) a draped aorta sign or periaortic stranding [ 108 , 109 ]. These signs are mostly based on CT characteristics of the mural thrombus.…”

Section: Unstable and Impending Rupture Of Thoracic Aorta Aneurysm (Taa)mentioning

confidence: 99%

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

et al. 2022

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Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.

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Section: Unstable and Impending Rupture Of Thoracic Aorta Aneurysm (Taa)mentioning

confidence: 99%

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

et al. 2022

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“…54 With advancements in imaging, diagnosis of PAU and IMH can be made with better confidence, transoesophageal echocardiography (TEE) leading from the front. 53,55…”

Section: Imaging Findingsmentioning

confidence: 99%

“…42 IBP is a relatively benign entity, those having a significant diameter and communicating with intercostal or lumbar artery leading to incomplete resorption. 2,33,38,55 The prognostic significance of FID is not clear.…”

Section: Prognosis and Outcomementioning

confidence: 99%

“…PAU complicated by subadventitial aneurysm, presence of acute FID, enlarging IBPs, bronchial compression or aortobronchial fistula, and signs of distal embolization require urgent surgical management either open surgery or TEVAR. 2,[4][5][6][8][9]16,18,23,33,55 TEVAR is preferable in patients showing signs and symptoms of abdominal or limb ischemia, those with associated infectious aortitis especially mycotic and anatomical abnormality like coarctation. 18, 76 Cho et al suggested medical management for PAU and also expected resolution of IMH with time.…”

Section: Managementmentioning

confidence: 99%

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Demystifying penetrating atherosclerotic ulcer of aorta: unrealised tyrant of senile aortic changes

Dev

Khorwal

Darbari

2021

J Cardiovasc Thorac Res

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This review article describes demographic features, comorbidities, clinical and imaging findings, prognosis, and treatment strategies in penetrating atherosclerotic ulcer (PAU) and closely related entities using google scholar web search. PAU is one of the manifestations of the acute aortic syndrome (AAS) spectrum. The underlying aorta invariably shows atherosclerotic changes or aneurysmal dilatation. Hypertension is the most common contributing factor, with chest or back pain being the usual manifestation. Intramural hematoma (IMH) is the second entity associated with both PAU and aortic dissection (AD), more so with the latter. Chest radiograph can show mediastinal widening, pleural, or pericardial fluid in rupture. Computed tomography angiography (CTA) is the imaging modality of choice to visualize PAU, with magnetic resonance imaging (MRI) and transoesophageal echocardiography (TEE) adding diagnostic value. Lesser-known entities of intramural blood pool (IBP), limited intimal tears (LITs), and focal intimal disruptions (FID) are also encountered. PAU can form fistulous communication with adjacent organs whereas IMH may propagate to dissection. CTA aids in defining the management, open or endovascular options in surgical candidates.

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Intramural Hematoma in Vertebrobasilar Dolichoectasia–Related Stroke: A Retrospective Analysis of Six Consecutive Patients

et al. 2022

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Acute Aortic Syndrome: Recent Trends in Imaging Assessment Using Computed Tomography Angiography

Cited by 3 publications

References 46 publications

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

Demystifying penetrating atherosclerotic ulcer of aorta: unrealised tyrant of senile aortic changes

Intramural Hematoma in Vertebrobasilar Dolichoectasia–Related Stroke: A Retrospective Analysis of Six Consecutive Patients

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