Type:
Educational Exhibit
Keywords:
Performed at one institution, Not applicable, Retrospective, Aneurysms, Education, CT-Angiography, Arteries / Aorta, Vascular
Authors:
M. D. Pomohaci1, M. Baila1, M. Buzoianu2, R. A. Capsa1, I. G. Lupescu2; 1Bucuresti/RO, 2Bucharest/RO
DOI:
10.26044/ecr2020/C-09052
Background
Background
I. The aorta
The aorta is the largest and main artery of the body carrying oxygenated blood from the heart to all the organ systems.
It has three histological layers: Fig. 1
- intima - thin endothelial layer;
- media - elastic lamella, smooth muscle and connective tissue;
- adventitia – connective tissue, nerves, lymphatics and the vasa vasorum;
Fig. 1: Aortic layers
It can be divided into the following segments and subsegments: Fig. 2
- The thoracic aorta segments: ascending aorta, aortic arch, descending aorta
- The abdominal aorta with: suprarenal, juxtarenal and infrarenal abdominal aorta
Fig. 2: Segments of the aorta
II. Aortic aneurysms
1.Definition: An aortic aneurysm is a dilatation involving all three layers of the aortic wall, exceeding the normal aortic diameter by a factor of 1.5 or more. Table 1
Table 1: Normal aortic diameters
References: 2
2.Measurements should always be perpendicular to the course of the aorta and thus should rely on multiplanar reformations more than on axial section. Fig. 3
Fig. 3: The measurement of the aortic diameter includes any wall calcifications or mural thrombi that are present.
3. Classification
Aortic aneurysms can be classified according to:
Type: Fig. 4
- true aneurysm - a dilatation of the entire arterial wall (most frequent);
- false aneurysm - disrupted wall that is contained by adventitia and perivascular connective tissue;
Fig. 4: A.B.= aneurysmal dilatation involving all the aortic wall layers;
C.D.= pseudoaneurysmal dilatation with accumulation of blood that enhances in arterial phase
Shape: Fig. 5
- fusiform – circumferential;
- saccular
Fig. 5: A. The dilatation involves the anterior wall of the aorta (blue arrow)
B. The dilatation is circumferential (red arrows)
Location
- Thoracic (involving the ascending aorta, aortic arch or the descending aorta);
- Abdominal (involving the suprarenal or the infrarenal segment);
III.Aortic aneurysm complications
The most common complications in aortic aneurysms are:
• Parietal hematoma/thrombosis;
• Dissection;
• Ulceration;
• Rupture;
• Mass effect on adjacent structures.
In our study the most frequent complication of the studied pathology was thrombosis (83,3%), but dissection and rupture are the most life threatening and are part of the acute aortic syndrome.