Acute aortic syndrome: what radiologists should know

Congress:

ECR 2020

Poster Number:

C-08278

Type:

Educational Exhibit

Keywords:

Emergency Imaging, Arteries / Aorta, Cardiovascular system, Emergency, CT, CT-Angiography, Contrast agent-intravenous, Acute, Not applicable

Authors:

V. Gandileva¹, R. D. Popova²; ¹Pleven/BG, ²Burgas/BG

DOI:

10.26044/ecr2020/C-08278

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08278

Fig. 1: Schematic illustration of the anatomy of the aortic wall and the three subtypes...

Fig. 2: Schematic illustration of DeBakey and Stanford classification.

Fig. 3: Non-enhanced MDCT showing displaced intimal calcifications in the descending...

Fig. 4: Axial, coronal and sagittal reconstruction images depict type A aortic...

Learning objectives

1. To discuss and illustrate key imaging features of aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. 2. To describe radiological findings that allow differential diagnosis between them. 3. To discuss in detail artifacts that can simulate AAS and to suggest CT protocol for their avoiding.

Background

The acute aortic syndrome (AAS) is a constellation of life-threatening conditions, which are manifestations of anatomic and pathophysiologic changes to the aortic wall with similar predisposing factors and indistinguishable clinical presentation. The typical symptoms and signs of AAS are sudden onset of chest pain with radiation to the back and hypertension. However, in some cases, the onset may be a manifestation of organ ischemia, including myocardial infarction, mesenteric ischemia, etc. According to the classical classification, the term includes aortic dissection (AD), intramural hematoma (IMH), and...

Findings and procedure details

Aortic dissection AD represents a tear in the aortic wall, subsequent separation of the layers of the aorta with the formation of two distinct flow channels. The risk factors include conditions that increase the stress on the wall (hypertension), and diseases with aortic medial abnormalities (connective tissue disorders, atherosclerosis, vasculitides, etc). There are two main classifications used in the clinical practice - Stanford and DeBakey classification. (fig. 2) The Stanford classification is the preferred one because of its simplicity - type A AD affects the...

Conclusion

AAS is a clinical emergency and radiologists should be familiar with specific imaging findings, which are crucial for the correct diagnosis.

Personal information and conflict of interest

V. Gandileva; Pleven/BG - nothing to disclose R. D. Popova; Burgas/BG - nothing to disclose

References

Eva Castañer, Marta Andreu, Xavier Gallardo, Josep Maria Mata, María Ángeles Cabezuelo, Yolanda Pallardó. CT in Nontraumatic Acute Thoracic Aortic Disease: Typical and Atypical Features and Complications. RadioGraphics 2003; 23:S93–S110 Susan E. Gutschow, Christopher M. Walker, Santiago Martínez-Jiménez, Melissa L. Rosado-de-Christenson, Justin Stowell, Jeffrey R. Kunin. Emerging Concepts in Intramural Hematoma Imaging. RadioGraphics 2016; 36:660–674 Valente T, Rossi G, Lassandro F, Rea G, Marino M, Muto M, et al. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol 2016; 89:20150825. Ueda T, Chin A,...