Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. On finding extensive descending aortic dissection extending into the abdominal aorta and left common carotid artery, further CTA was performed of the neck, abdomen and pelvis as well as a ECG-gated CTA of the aortic root. In a very small minority, an underlying connective tissue disorder may be present. The CTPA is of good quality and no pulmonary embolus is identified. [Medline] . 137 (3): 250-258. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2081,"mcqUrl":"https://radiopaedia.org/articles/stanford-classification-of-aortic-dissection-1/questions/289?lang=us"}. 1991; 180: 297 – 305. 6. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 1949-1972. Lombardi JV, Hughes GC, Appoo JJ, Bavaria JE, Beck AW, Cambria RP, Charlton-Ouw K, Eslami MH, Kim KM, Leshnower BG, Maldonado T, Reece TB, Wang GJ. Diagnostic imaging plays a substantial role in meeting this objective in the case of thoracic aortic dissection. Shu C, Wang T, Li QM, Li M, Jiang XH, Luo MY, et al. 7. One option to repair an aortic dissection is for an Interventional Radiologist to perform an aortic fenestration procedure. Infectious aortitis may be secondary to tuberculosis, syphilis, or infection with Salmonellaor … (2010) Radiographics : a review publication of the Radiological Society of North America, Inc. 30 (2): 445-60. doi:10.1148/rg.302095104 - Pubmed. The majority of aortic dissections are seen in elderly hypertensive patients. (2018). Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. Causes include: Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification (which dictates management). Saunders Ltd. ISBN:0702030465. A typical helical scanning protocol for aortic dissection includes the following parameters: 5-mm collimation, 1.5 pitch, and 7.5-mm imaging spacing. 21 GOV.UK. Macura KJ, Corl FM, Fishman EK et-al. In such instances, a number of features are helpful 3: Chronic dissection flaps are often thicker and straighter than those seen in acute dissections 3. It has reported sensitivity and specificity of nearly 100% 3,5. It is also seen in other collagen vascular disorders such as rheumatoid arthritis and ankylosing spondylitis. Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. 2003). The radiologic assessment of patients suspected of having an aortic dissection must be based on an understanding of the treatment options and how these are to be employed in any clinical setting. 4. Dissection is the most common aortic emergency, being more prevalent than thoracoabdominal aortic aneurysm rupture (Castaner et al. Acute dissection of the descending aorta: noncommunicating versus communicating forms. A total of 29 women (mean [standard deviation (SD)] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. Primer of Diagnostic Imaging, Expert Consult- Online and Print. 2001;177 (1): 207-11. Aortic arch dissection: a controversy of classification. Figure 8.5 Contrast enhanced Computed Tomography of the Chest, Abdomen and Pelvis, intimal flap seen associated with aortic dissection. Conventional digital subtraction angiography has historically been the gold standard investigation. 8. McMahon MA, Squirrell CA. 2005;184 (4): 1225-30. Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Traditionally investigated by contrast angiography, the last two decades have seen considerable developments in the diagnosis of aortic disease by echocardiography, CT, and MRI. (2004) The Annals of thoracic surgery. Dissections involving the aortic root should ideally be assessed with ECG-gated CTA which nearly totally eliminates pulsation artefact. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. Fourteen patients with aortic dissection without intimal rupture were examined by means of magnetic resonance (MR) imaging, computed tomography (CT), or both. Acute thoracic dissection is life-threatening and requires immediate diagnosis and treatment (Castaner et al. Emergent surgical repair of aortic dissection and resuspension of aortic valve. 2003;181 (2): 309-16. 2. Sebastià C, Pallisa E, Quiroga S et-al. 2. 79 (3): 567-73. 46 (2): 175-90. CT is the principal modality used to diagnose acute aortic dissection (AAD). The aortic root at the mid aortic sinus is 5.4 cm. Gleeson CE, Spedding RL, Harding LA, et al The mediastinum—Is it wide? Hurwitz LM, Goodman PC. Widening of the aorta on chest X-ray 3. Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. There have been efforts to construct a clinical decision rule stratify risk of acute aortic dissection and avoid over-investigation. 12. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health problems. Abstract The classic entity of life-threatening aortic dissection represents one pathology of a spectrum of acute conditions coined the acute aortic syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained aortic rupture of any cause. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics. The doctor may use one or more of these: X-ray. (2014) Radiology. Dissection flap extending from the aortic root down to the level of the upper abdominal aorta. Vasile N, Mathieu D, Keita K, Lellouche D, Bloch G, Cachera JP. This treatment uses a catheter (tube) to … Depending on the extent of dissection and occlusion of aortic branches, end-organ ischemia may also be present (seen in up to 27% of cases) 5, including: If the aortic dissection involves the aortic root it may result in involvement of the coronary arteries and can present similarly to ST-elevation myocardial infarction on an ECG. 2019]. Diagnostic Imaging in the Evaluation of Suspected Aortic Dissection -- Old Standards and New Directions New England Journal of Medicine, Vol. Findings: There was a left, apical, pleural cap. (2019) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. Mosby. 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