File aortic disease

Imaging of Aorta disease Nguyen Khoi Viet, MD Department of Diagnostic Radiology Bach Mai Hospital, Hanoi Aorta The aorta is the largest artery in the body and is the blood vessel that carries oxygen-rich blood away from the heart to all parts of the body The section of the aorta that runs through the chest is called the thoracic aorta and, as the aorta moves down through the abdomen it is called the abdominal aorta Imaging • • • • • Ultrasound X-ray CT-scanner MRI Angiography Ultrasound X-ray Angiography CT-scanner MRI Table Contents • Acute aortic syndrome - Aortic dissection - IMH - PAU • Aortic Aneurysm • Traumatic aortic injury • Aortic stenosis: Vasculitis (takayasu arthritis ) Mass, coracrtation AorticDissection Dissection Aortic • Longitudinal cleavage of the aortic media by dissecting column of blood • Intimal flap consists of: - intima - media (inner 2/3) Aortic stenosis • • • • • • • atherosclerosis Coartation of the Aorta midaortic dysplastic syndrome aortoiliac occlusive disease: lerich syndrome vasculitis: takayasu arteritis (acute, chronic) Aortic dissection postoperative stenosis: retroperitoneal fibrosis BN n÷, 48 tuổi, lâm sàng siêu âm doppler nghi hẹp tắc mạch nhiều nơi Xơ vữa huyết khối dài lan toả ĐM chủ xuống-chủ bụng, có vị trí hẹp nặng ĐMCB Hẹp gốc ĐM thận trái xơ vữa Takayasus arteritis Radiographics, 1997:17:579-594 • a primary arteritis of unknown origin that commonly affects the aorta and its major branches as well as the pulmonary artery • Incidence: 2-3 cases per year per million • Young women, M:F=1:10 • Pathology: panarteritis (inflammatory mononuclear cell infiltration) marked intimal proliferation and fibrosis, media scarring & vascularization, thrombosis, luminal narrowing systemic or prepulseless phase • CT scans: mural thickening and contrast enhancement changes (doubling pattern: low inside ring, high outside ring ) • Mural thickness decreases after steroid therapy late or occlusive phase • stenosis, occlusion, mural calcification, intraluminal thrombus, or aneurysmal dilatation • Stenosis: descending thoracic, abdominal aorta, subclavian, CCA, renal a • Dilatation: ascending aorta, innominate artery Four kinds of stenosis Type I - Classic pulseless type that involves the brachiocephalic trunk, carotid arteries, and subclavian arteries Type II - Combination of type I and III Type III - Atypical coarctation type that involves the thoracic and abdominal aortas distal to the arch and its major branches Type IV - Dilated type that involves extensive dilatation of the length of the aorta and its major branches Vasculitis M/54 chest pain BN n÷, 24 tuổi, đo HA chênh lệch tay-chân, siêu âm doppler mạch cảnh có hẹp ĐM d-ới đòn cảnh gốc trái VRT: Hẹp ĐM d-ới đòn cảnh gốc trái từ gốc đoạn dàI, bờ Hẹp trung bình thân cánh tay đầu, hẹp nhẹ gốc ĐMCG d-ới đòn phải Cùng bệnh nhân Viêm động mạch Takayasu Hẹp nhẹ gốc ĐM thân tạng Tắc động mạch thận trái Coarctation of the Aorta ã Congenital obstructive anomaly of the aortic lumen • Typically occurs in the aortic isthmus, between the left subclavian artery and the ductus • More than half of cases show tubular hypoplasia of the transverse portion of the aortic arch with dilatation of the supraaortic vessels • Associated lesions : – VSD, bicuspid aortic valve – aneurysms of the ascending aorta, ductus, intercostal arteries, and circle of Willis, – stenosis of the left subclavian artery, and aberrant right subclavian artery RadioGraphics 2003; 23:S79–S91 M/27, chest pain 2009-01-26 Mass 2008-1-17 2008-3-17 M/54, Sudden abdominal pain Conclusion • CT and MRI angiography of the aorta is currently the imaging technique of choice for evaluation patients with aortic disease • Various pitfalls and artifacts are potentially confusing the proper diagnosis Xin cảm ơn thầy bạn đồng nghiệp! ... Contents • Acute aortic syndrome - Aortic dissection - IMH - PAU • Aortic Aneurysm • Traumatic aortic injury • Aortic stenosis: Vasculitis (takayasu arthritis ) Mass, coracrtation AorticDissection... aortic lumen (single or multiple); thickning aorta wall Aortic Dissection vs PAU Aortic Aneurysm Aortic Aneurysm • Localized or diffuse dilatation of aorta • True aneurysm vs False aneurysm Aortic. .. Focal calcification Traumatic aortic injury Common site: aortic isthmus (between aortic arch and descending aorta) Review : Traumatic aortic dissection • • Location – Aortic isthmus : 90%, just