Aortic dissection class 3: a diagnostic challenge for the radiologist

Congress:

ECR 2020

Poster Number:

C-13161

Type:

Educational Exhibit

Keywords:

Performed at one institution, Observational, Retrospective, Dissection, Diagnostic procedure, CT-Angiography, Thorax, Emergency, Arteries / Aorta, Emergency Imaging

Authors:

A. J. Láinez Ramos-Bossini , E. Ruiz Carazo, M. D. Garcia Roa, G. lopez milena, M. D. C. Pérez García, E. Moya Sanchez; Granada/ES

DOI:

10.26044/ecr2020/C-13161

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-13161

Fig. 1: Classification of acute aortic syndromes (adapted from the 2014 ESC...

Fig. 2: Schematic diagram showing the anatomical basis of aortic dissection class 3 on...

Fig. 3: CT angiography of the aorta with cardiac gating (axial views). Initial (A and...

Fig. 4: CT angiography of the aorta, axial view (A) and volume rendering in oblique...

Learning objectives

To review the main CTfindings of aortic dissection class 3 (AD3) apropos of five cases diagnosed in our hospital.

Background

Acute aortic syndrome (AOS) is a radiological emergency with high mortality. Currently, the European Society of Cardiology recognizes five subtypes of AOS based on Svensson’s classification. Whilst most radiologists are familiar with classic aortic dissection (CAD), penetrating atherosclerotic ulcer, intramural hematoma (IH), and traumatic aortic injury, AD3 has been reported to be less acknowledged. Radiologically, AD3 is characterized by an intimal tear associated with a focal bulge of the aortic outline. With the aim of illustrating the mainCT findings of this entity, we present five...

Findings and procedure details

1.Classification of acute aortic syndromes Acute aortic syndromes (AOS) are emergency conditions involving the aorta that share similar characteristics. They occur when blood pervades the aortic wall, either due to disruption of the intima/media layers or to rupture of the vasa vasorum. The local inflammatory response to blood may provoke aortic dilation and rupture. Apart from the DeBakey and Stanford classification systems, Svensson et al. established a classificationdifferentiating fivetypes of AOS, which was later adopted by the European Society of Cardiology and the American Heart...

Conclusion

Aortic dissection class 3 is an uncommon, yet potentially fatal condition. Its main CT findings consist of a focal bulging of the aortic contour with a "mushroom cap" appearance. In doubtful cases, cardiac gatingcan be helpful, although the familiarity of the radiologist with AD3 is the main diagnostic predictor. Further studies are needed to fully understand the mechanisms underlying this dissection and its optimal management.

Personal information and conflict of interest

A. J. Láinez Ramos; Granada, GRANADA/ES - nothing to disclose E. Ruiz Carazo; Granada/ES - nothing to disclose M. D. García Roa; Granada/ES - nothing to disclose G. Lopez Milena; Granada/ES - nothing to disclose M. D. C. Pérez García; Granada/ES - nothing to disclose E. Moya Sánchez; Granada/ES - nothing to disclose

References

1. Svensson LG, Labib SB, Eisenhauer AC, et al. Intimal Tear Without Hematoma. Circulation. 1999;99:1331-6, http://dx.doi.org/10.1161/01.CIR.99.10.1331. 2. Erbel R, Alfonso F, Boileau C, et al. Task Force on Aortic Dissection, European Society of Cardiology. Diagnosis and management of aortic dissection Task Force on Aortic Dissection European Society of Cardiology. Eur Heart J. 2001;22:1642-81, 10.1053/euhj.2001.2782. 3.Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. J Am Coll Cardiol. 2010;55:e27-129, http://dx.doi.org/10.1016/J.JACC. 015201002. 4. Chirillo...