The diagnostic accuracy of the mediastinal width on supine anteroposterior chest radiographs with nontraumatic Stanford type A acute aortic dissection

Funakoshi, Hiraku; Mizobe, Michiko; Homma, Yosuke; Nakashima, Yoshiyuki; Takahashi, Jin; Shiga, Takashi

doi:10.1002/jgf2.155

Cited by 9 publications

(11 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…AAD patients sometimes present predominantly with neurological symptoms from cerebral ischemia [ 4 ] and often have sudden and severe pain in the chest, back and abdomen [ 5 ]. 60–70% of AAD patients are affected at the ascending aorta, which are classified as Stanford type A [ 6 ]. Nontraumatic Stanford type A acute aortic dissection (NTAD) is a life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

Chen

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background To investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate. Methods The demographic and clinical data were retrospectively collected and analyzed from 118 AAD patients admitted to the Affiliated Hospital of Hangzhou Normal University from June 2016 to April 2019. All patients underwent surgical treatment and were grouped into death and survival groups. The risk factors affecting postoperative in-hospital death were analyzed using multivariate logistic regression analysis. Results The male to female ratio in the patients was 3.8:1 and the mean age was 50.11 ± 9.91 years. The patient’s main comorbidities were hypertension (70.33%) and coronary heart disease (10.17%). The main symptoms included chest pain and back pain (72.89%). The highest incidence of complications was pericardial effusion (48.31%), followed by pleural effusion (22.88%). The mean systolic blood pressure, white blood cell count and D-dimer in the patients were over the ranges of normal people. The incidences of cardiac and renal insufficiency were 18.64% and 16.95% respectively, and the postoperative in-hospital mortality rate was 12.71%. Univariable analysis showed that age, renal insufficiency, cardiac insufficiency, D-dimer level, cardiopulmonary bypass time, operation time, blood transfusion volume and postoperative hemostasis were significant factors leading to the death (P < 0.05). Multivariate logistic regression analysis showed that age > 65, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis were independent risk factors for the death (P < 0.05). Conclusions AAD patients frequently have underlying diseases with pain as the main symptom. Age > 65 years, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis are significantly risk factors for postoperative mortality.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

Chen

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Consistent with the human literature, the sensitivity for detection of aortic dilatation or aneurysm on thoracic images relates to the location and extent of dilatation, with the proximal aorta more difficult to assess than the distal aorta due to overlap with the cardiac silhouette 25 . Several human studies evaluated the size of the aortic knob width, 14–16 aortic knob width compared to the width of the mediastinum, or just the mediastinal width for detection of SH or aneurysm 18,19 . On frontal thoracic radiographs of people, distances between the aortic knob and trachea of ≥3.5 cm and ≥4.0 cm, had positive predictive values of 94 and 97 for SH, respectively 16 .…”

Section: Discussionmentioning

confidence: 99%

An observational thoracic radiographic study of aortic remodeling in dogs with confirmed systemic hypertension

Holland

Hudson

Hofmeister

2022

Vet Radiology Ultrasound

View full text Add to dashboard Cite

Sustained systemic hypertension (SH) has been shown to cause target organ damage to various tissues in dogs and cats, including the aorta. Aortic dilatation occurs most commonly secondary to SH in people and develops prior to an aortic aneurysm. Our hypothesis was that blinded reviewers could be trained to recognize variable alterations of aortic shape and size on thoracic radiographs of canine patients with SH. A retrospective, observational, cross-sectional study was performed with three blinded reviewers evaluating thoracic radiographic images of 21 dogs with normal blood pressure compared to 145 dogs with system hypertension. Lateral radiographs showed variable aortic undulation and disproportionate enlargement of a portion of the aorta between the ascending and proximal descending aorta compared to the descending aorta just cranial to the diaphragm. On orthogonal projections, the aortic arch to proximal descending aorta bowed laterally similar to changes reported in people with the formation of an aortic "knob." After completing a training module, reviewers of the thoracic images had a 74% agreement with Fleiss' Kappa of 0.50 indicating moderate agreement recognizing SH changes to the thoracic aorta. The more experienced blinded reviewers had accuracies of 85% and 80% for identifying systemic hypertension, slightly better than the less experienced reviewer at 76%. The ratio of thoracic cavity width to aortic knob width was significantly different between the groups (median ratio 3.4 SH vs 4.1 normal). Evidence of target organ damage (TOD) to the thoracic aorta may prompt earlier recognition and treatment for systemic hypertension.

show abstract

“…A mediastinal width >87 mm demonstrated high sensitivity in the diagnosis of a probable Stanford type A AAD. 8 If we had focused on these findings and had performed CTA before CAG, the treatment plan would have changed to emergency surgery. If AAD is suggested in an ED, POCUS is useful; however, detecting aortic dissection is occasionally difficult depending on the form.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic dissection with highly compressed true lumen: unanticipated pitfall of point-of-care ultrasonography

et al. 2021

View full text Add to dashboard Cite

A 46-year-old man presented with sudden onset of chest pain. He was in cardiogenic shock at arrival. Based on the results of ECG and echocardiogram, he was diagnosed with ST-segment elevation myocardial infarction. Point-of-care ultrasonography (POCUS) did not reveal acute aortic dissection (AAD). During an emergency coronary angiography, aortic dissection was detected and computed tomographic angiography (CTA) revealed Stanford type A AAD with a highly compressed true lumen. Because of this form of aortic dissection, the enlarged false lumen could be potentially misidentified as a normal aorta in POCUS. Although POCUS is useful when AAD is suspected, we should not overestimate its findings and lower the threshold for CTA.

show abstract

The diagnostic accuracy of the mediastinal width on supine anteroposterior chest radiographs with nontraumatic Stanford type A acute aortic dissection

Abstract: Background: Nontraumatic Stanford type A acute aortic dissection is a life-threatening

Cited by 9 publications

References 12 publications

Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

An observational thoracic radiographic study of aortic remodeling in dogs with confirmed systemic hypertension

Acute aortic dissection with highly compressed true lumen: unanticipated pitfall of point-of-care ultrasonography

Contact Info

Product

Resources

About