Aortic Pathology

  • Acute aortic syndrome
    • Aortic dissection
      • Blood gets in the medial layer of the aortic wall through a tear or penetrating ulcer in the intima
      • Blood collection then builds up and forms a channel within aortic wall
      • Patients generally are elderly and hypertensive, or have a CT disorder, or pregnant
      • Symptoms:
        • HTN
        • Ant. or post. chest pain; “tearing sensation”
        • Difference in arm BP
        • May have end-organ ischemia
          • Limb, internal organs, stroke, or paraplegia (if the artery of Adamkiewicz/ aka great anterior radiculomedullary artery is affected
        • Patient may have Beck’s triad if rupture is into pericardial space
          • Low BP / weak pulse
          • Muffled heart sounds
          • Increased JVP
      • Clinical presentation:
        • Acute: <14 days of symptoms
        • Subacute: 14 days – 3 months
        • Chronic: >3 months
      • Pathology:
        • Medial degeneration of the tunica interna (by increased pressure (HTN) or CT disease (Marfan’s/EDS)
      • Stanford classification
        • Type A – Affects Ascending Aortic Arch
          • 60%
          • needs surgery
          • may result in coronary artery occlusion, aortic incompetence, or rupture into pericardial sac
        • Type B – Begins Beyond Brachiocephalic vessels
          • 40%
          • dissection is distal to left subclavian artery
          • medical management – BP control!
    • Penetrating aortic ulcer (PAU)
      • Often occurs (~50%) with a concomitant abdominal aortic aneurysm  
      • Seen in CT as a contrast-filled outpouching; “mushroom-like”
    • Intramural hematoma
      • Atypical type of aortic dissection due to hemorrhage into the wall from the vasa vasorum without an intimal tear
      • Can occur after blunt chest trauma or with a PAU
  • Aortic aneurysms
    • Thoracic
      • Pretty uncommon
      • Males > Females
      • Age 50-60
      • One DDX is an aortic spindle
        • Circumferential bulge at proximal descending thoracic aorta (normal anatomic variant)
    • Abdominal (AAA)
      • The 10th most common cause of death in the western world
      • ~10% of patients age 65+ have an AAA
      • Commonly an incidental finding during imaging
      • Abdominal aortic rupture = most significant complication
        • High mortality (60-83% die)
      • 25% are associated with common iliac artery (CIA) aneurysm
      • Screening = best with ultrasound, unless patient is really gassy and/or obese
      • CT = gold standard for evaluation, pre-op planning
      • Signs of impending rupture:
        • Draped aorta sign
        • High-attenuation crescent sign
        • Tangential calcium
author: last edited: Jan. 23, 2019, 1:29 p.m. | pk: 156 | unpublished

https://radiopaedia.org/articles/acute-aortic-syndrome?lang=us 

 

Outline plagarized by Brittany Mammano, MS-4