Understanding acute aortic syndrome: guide for a fast diagnosis and accurate reporting

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2014

Poster Number:

C-2221

Type:

Scientific Exhibit

Keywords:

Cardiovascular system, Vascular, CT-Angiography, CT, Echocardiography, Complications, Education, Structured reporting, Dissection, Acute, Blood

Authors:

M. C. Ageitos Casais, A. X. Martínez de Alegría Alonso, A. Arango, S. Baleato González; Santiago de Compostela/ES

DOI:

10.1594/ecr2014/C-2221

DOI-Link:

https://dx.doi.org/10.1594/ecr2014/C-2221

Fig. 3: Aortic dissection: Diagnostic findings - Intimal flap

Fig. 1: Aortic dissection: Pathogenesis and Stanford classification

Fig. 16: Penetrating atheromatous ulcer: pathogenesis

Fig. 6: Clues to identify false lumen - Thrombosed false lumen - Beak sign

Fig. 2: Aortic dissection: diagnostic findings

Fig. 10: Aortic dissection: complications - Involvement of visceral arteries

Fig. 17: Penetrating atheromatous ulcer: ct findings

Aims and objectives

To illustrate pathogenesis and radiological features of intramural hematoma, penetrating atherosclerotic ulcer and aortic dissection and evaluate its prognosis and possible complications. To review radiologic findings on each entity focusing on diagnostic pearls, potential pitfalls and systemic complications. To describe the necessary reporting data that the surgeon needs to plan an adequate treatment on each case.

Methods and materials

CT examinations performed at our institution over a 5-year period (2009-2013) in acute aortic syndrome cases and its follow-up studies are retrospectively reviewed. Radiologic features found in each entity within this syndrome as well as early and late complications are schematized, pointing out key features that prompt to a correct diagnosis and illustrating common mistakes that radiologists must be aware of.

Results

1. AORTIC DISSECTION Most frequent cause of aortic emergency. High mortality without urgent treatment. CT has high sensibility and specifity, nearly 100%. RISK FACTORS: Hypertension, Marfan syndrome, Ehler-Danlos syndrome, Turner syndrome, medial cyst necrosis. PATHOGENESIS: Laceration of intimal and internal medial layer that leads to blood entry within media through intimal tear and subsequent development of a double aortic lumen. CLASSIFICATION: According to Stanford classification: - TYPE A: Involves ascending aorta. Needs urgent surgical treatment. - TYPE B: Descending aorta (distal to subclavian artery origin)....

Conclusion

Aortic dissection is the most frequent and most life-threating entity of the Acute Aortic Syndrome, needing a fast and adequate diagnosis. That is why radiologists must know how to differentiate between dissection, intramural hematoma and penetrating ulcer at a glance. An adequate CT protocol is necessary to make an accurate diagnosis, including an unenhanced CT and in some cases of aortic dissection, even a delayed phase. Surgeons need an adequate report with detailed information about extension, location and systemic involvement to confidently plan either an...

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References

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