Uncommon Congenital and Acquired Aortic Diseases: Role of Multidetector CT Angiography

Abstract

State-of-the-art multidetector computed tomographic (CT) technology has replaced invasive angiography for evaluation of patients suspected to have aortic disease. Although most aortic disease is associated with atherosclerosis (ie, aneurysms and dissection), the spectrum of aortic disease is vast and includes various congenital and acquired entities. Radiologists should also be familiar with uncommon aortic diseases, which are divided into those that are congenital in origin and acquired disorders, and with their findings at multidetector CT. The first group includes patent ductus arteriosus, aortic hypoplasia, aortic coarctation, interrupted aortic arch, aortopulmonary window, common arterial trunk, supravalvular aortic stenosis, and vascular rings. The acquired disorders include aortic dissection due to extension of a coronary artery dissection, Marfan syndrome, large-vessel vasculitis such as Takayasu arteritis, and mycotic aneurysms. Finally, specific conditions associated with therapeutic maneuvers--such as recoarctation, stent-graft rupture, and endoleaks--can also be assessed with multidetector CT. Multidetector CT is an alternative tool helpful in establishing the primary diagnosis, defining anatomic landmarks and their relationships, and identifying associated cardiovascular anomalies. It is also an adjunct in the evaluation of complications during follow-up.

Congenital thoracic arterial anomalies in adult: CT overview

“…There are three forms of double aortic arch: right arch dominant (75%), left arch dominant (20%), and arches of the same size (5%). A portion of the arch is atretic in about one-third of cases (5,10). The descending aorta is usually on the left side, but it may also be at the midline or on the right side.…”

“…Coarctation may cause congestive heart failure, hypertension and blood pressure gradients between lower and upper extremities. Intimal thickening and disruption of elastic tissue occur at the distal part, which cause a predisposition to infective endarteritis, intimal dissection, and aneurysm (2,5,13) There are two types of aortic coarctation: preductal (infantile) and postductal (adult). In the preductal type, segmental narrowing of the aortic arch due to tubular hypoplasia beginning at the level of origin of the brachiocephalic artery accompanies focal narrowing distal to the ductus arteriosus.…”

“…In the preductal type, segmental narrowing of the aortic arch due to tubular hypoplasia beginning at the level of origin of the brachiocephalic artery accompanies focal narrowing distal to the ductus arteriosus. In the postductal type, there is a focal narrowing at the distal part of the ductus arteriosus or left subclavian artery (2,5,13).…”

“…Absence of the right ventricular infundibular septum results in VSD. There are two classification systems for truncus arteriosus: Collett-Edwards and Van Praagh (5,25). There are four types in each classification system based on the origins of the pulmonary arteries (Fig.…”

Non-Coronary Findings on Cardiac Computed Tomography in Adults: What Radiologists Should Know

“…3) [15,16]. Other associated anomalies include ventricular septal defect, sinus venosus ASD, hypoplastic left heart syndrome, mitral valve malformation, truncus arteriosus, right aortic arch, supravalvular pulmonary artery stenosis, and left subclavian artery dilatation [17]. Cardiac CT can provide anatomical details of the aorta and the narrowing segment as well as associated cardiovascular anomalies and collateral vessels for initial diagnosis [13].…”