scholarly journals Symptoms Matter: A Symptomatic but Radiographically Elusive Ascending Aortic Dissection

2018 ◽  
Vol 28 (01) ◽  
pp. 031-033 ◽  
Author(s):  
Dimitra Papanikolaou ◽  
Mohammad Zafar ◽  
Maryam Tanweer ◽  
Mahnoor Imran ◽  
Mohamed Abdelbaky ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Similar Case ◽  
Ascending Aortic Aneurysm ◽  
History Of ◽  
Hemiarch Replacement ◽  
Ascending Aortic Diameter ◽  
Aortic Size

AbstractSymptoms attributable to a thoracic aortic aneurysm (TAA) are a separate indication for prophylactic repair, irrespective of aortic size. We present the case of a 56-year-old female with a history of a thoracic ascending aortic aneurysm (TAAA) and four other heart and arch vessel abnormalities who presented to us with chest pain radiating to her back. Computed Tomography and echocardiography showed no evidence of a dissection and revealed a maximal ascending aortic diameter of 4.2 cm. The patient subsequently underwent root-sparing ascending aortic and hemiarch replacement due to her threatening symptomatology. A focal dissection was discovered intraoperatively, resembling a similar case previously reported by our team.

scholarly journals Self-navigated 3D whole-heart MRA for non-enhanced surveillance of thoracic aortic dilation: a comparison to CTA

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Poskaite ◽  
M Pamminger ◽  
C Kranewitter ◽  
C Kremser ◽  
M Reindl ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Dilation ◽  
Subjective Image Quality ◽  
Contrast Enhanced ◽  
Whole Heart ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Funding Acknowledgements Type of funding sources: None. Background The natural history of thoracic aortic aneurysm (TAA) is one of progressive expansion. Asymptomatic patients who do not meet criteria for repair require conservative management including ongoing aneurysm surveillance, mostly carried out by contrast-enhanced computed tomography angiography (CTA). Purpose To prospectively compare image quality and reliability of a prototype non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA). Methods Self-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 8.6 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen’s Kappa statistics. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis. Results Overall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1-2] for self-navigated MRA and 1.5 [IQR 1-2] for CTA (p = 0.717). For MRA a perfect inter-observer agreement was found for presence of artefacts and subjective image sharpness (κ=1). Subjective signal inhomogeneity correlated highly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78-0.824, all p <0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed excellent correlation (r = 0.997, p < 0.0001) without significant inter-method bias (bias -0.0278, lower and upper limit of agreement -0.74 and 0.68, p = 0.749). Inter- and intraobserver correlation of aortic aneurysm as measured by MRA was excellent (r = 0.963 and 0.967, respectively) without significant bias (all p ≤ 0.05). Conclusion Self-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and by offering excellent image quality. Abstract Figure.

scholarly journals A Neglected Case of Thoracic Aortic Aneurysm– A Case Report

2015 ◽  
Vol 16 (1) ◽  
pp. 53-55
Author(s):  
Sohely Sultana ◽  
Mohammad Faisal Ibn Kabir ◽  
Tarana Yasmin ◽  
Shyamal KR Roy ◽  
Asish Sarkar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Descending Aorta ◽  
X Ray ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Surgery Department ◽  
Medical University

A 52 year old female reported to surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with dysphasia and exertional chest pain. With detailed history and examination she was diagnosed as a case of epigastric mass and undergone X-ray chest. The report revealed enlarged mediastinal shadow with suspicion of thoracic aortic aneurysm. X-ray chest was followed by contrast enhanced CT scan which revealed a large partially thrombosed aneurysmal dilatation of the aortic arch with sharp kinking (bend) at distal end of aneurysm and beginning of descending aorta. Then the patient was referred to cardiac surgery for immediate management. But the patient refused to have a surgery. Then two months later the patient again presented with chest pain and admitted in DMCH. But the patient died.DOI: http://dx.doi.org/10.3329/jom.v16i1.22405 J MEDICINE 2015; 16 : 53-55

scholarly journals Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

2013 ◽  
Vol 6 ◽  
pp. OJCS.S11446 ◽  
Author(s):  
Shigeki Masuda ◽  
Nobuhiro Takeuchi ◽  
Masanori Takada ◽  
Koichi Fujita ◽  
Yoshiharu Nishibori ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Rupture ◽  
Prosthetic Graft ◽  
Sigmoid Colon Cancer ◽  
Causative Organism ◽  
Protein Levels ◽  
Reactive Protein ◽  
History Of

A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes.

Double-locus lymphoplasmacytic aortitis

2017 ◽  
Vol 26 (3) ◽  
pp. 231-233
Author(s):  
Szabolcs Miskolczi ◽  
Mary N Sheppard ◽  
Gábor Bogáts ◽  
Laszlo Göbölös
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Incidental Finding ◽  
Intramural Hematoma ◽  
Acute Aortic Syndrome ◽  
Immunoglobulin G4 ◽  
Thoracic Computed Tomography ◽  
Systemic Pathology ◽  
Work Up

Thoracic aortic aneurysm is an indication for major cardiovascular operative procedures. The etiology is usually hypertension and/or atherosclerotic disease; reaching a certain diameter often results in acute aortic syndrome. Immunoglobulin G4-related aortitis, characterized by lymphoplasmacytic vascular tunica media induration without well-defined underlying infectious or autoimmune systemic causes, is uncommon. Histological similarity to immunoglobulin G4 disease in other organs suggests that this aortitis might be a manifestation of systemic pathology. We describe a case of double-locus lymphoplasmacytic aortitis in a 72-year-old man who had the incidental finding of intramural hematoma on elective thoracic computed tomography as part of a respiratory work-up.

scholarly journals Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sabry Omar ◽  
Tyler Moore ◽  
Drew Payne ◽  
Parastoo Momeni ◽  
Zachary Mulkey ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Thoracic Aortic Aneurysm ◽  
Ascending Aorta ◽  
Screening Methods ◽  
Significant Past Medical History ◽  
Iliac Arteries ◽  
Aortic Aneurysm And Dissection ◽  
History Of ◽  
Chest X Ray

We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

scholarly journals Development and Validation of a Predictive Model to Identify Patients With an Ascending Thoracic Aortic Aneurysm

2021 ◽  
Author(s):  
Makoto Mori ◽  
Geliang Gan ◽  
Yanhong Deng ◽  
Sameh Yousef ◽  
Gabe Weininger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Risk Model ◽  
Tertiary Care ◽  
Aortic Aneurysms ◽  
Prediction Algorithm ◽  
Increased Risk ◽  
Targeted Screening ◽  
Computed Tomography Scans ◽  
History Of

Background Screening protocols do not exist for ascending thoracic aortic aneurysms (ATAAs). A risk prediction algorithm may aid targeted screening of patients with an undiagnosed ATAA to prevent aortic dissection. We aimed to develop and validate a risk model to identify those at increased risk of having an ATAA, based on readily available clinical information. Methods and Results This is a cross‐sectional study of computed tomography scans involving the chest at a tertiary care center on unique patients aged 50 to 85 years between 2013 and 2016. These criteria yielded 21 325 computed tomography scans. The double‐oblique technique was used to measure the ascending thoracic aorta, and an ATAA was defined as >40 mm in diameter. A logistic regression model was fitted for the risk of ATAA, with readily available demographics and comorbidity variables. Model performance was characterized by discrimination and calibration metrics via split‐sample testing. Among the 21 325 patients, there were 560 (2.6%) patients with an ATAA. The multivariable model demonstrated that older age, higher body surface area, history of arrhythmia, aortic valve disease, hypertension, and family history of aortic aneurysm were associated with increased risk of an ATAA, whereas female sex and diabetes were associated with a lower risk of an ATAA. The C statistic of the model was 0.723±0.016. The regression coefficients were transformed to scores that allow for point‐of‐care calculation of patients' risk. Conclusions We developed and internally validated a model to predict patients' risk of having an ATAA based on demographic and clinical characteristics. This algorithm may guide the targeted screening of an undiagnosed ATAA.

scholarly journals Early postoperative effects of the hypothermia level during hypothermic circulatory arrest in patients with ascending aortic aneurysm

2020 ◽  
Vol 25 (8) ◽  
pp. 3419
Author(s):  
B. N. Kozlov ◽  
D. S. Panfilov ◽  
E. L. Sonduev ◽  
I. V. Ponomarenko
Keyword(s):  
Aortic Aneurysm ◽  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Ascending Aortic Aneurysm ◽  
Significant Difference ◽  
Temperature Regimen ◽  
Hypothermia Group ◽  
Hemiarch Replacement

Aim. To compare the effectiveness and safety of ascending aortic hemiarch replacement performed during hypothermic circulatory arrest with different temperature regimens.Material and methods. The study included 104 patients with ascending aortic aneurysm, who underwent ascending aortic hemiarch replacement under hypothermic circulatory arrest and antegrade cerebral perfusion. Depending on the temperature regimen, all patients were divided into two comparable groups: group 1 (n=28) — patients operated on under mild hypothermia (29-31oС), group 2 (n=76) — patients operated on under moderate hypothermia (25-28oC).Results. Comparative analysis of intraoperative data between groups of patients with mild and moderate hypothermia revealed a significant difference in the duration of cardiopulmonary bypass (111 [97; 135] min vs 125 [108.5; 170] min, p=0,031) and surgery (240 [210; 270 ] min vs 275 [240; 330] min, p=0,003). In the early postoperative period, the best results were also obtained in patients of mild hypothermia group. In these patients, compared with moderate hypothermia group, there was a lower frequency of reoperation due to bleeding (3,5% vs 5,2%, p=0,572), a decrease in transfused fresh frozen plasma volume (2 [2; 4] vs 4 [2; 4], p=0,03), a decrease in the ventilatory support duration (10 [7; 16] hours vs 18 [10; 24] hours, p=0,002), as well as a bed-day decrease in intensive care unit (2 [2; 3] and 3 [2; 4] days, p=0,005). No neurologic deficit was found in any of the patients. In-hospital mortality had no significant intergroup differences (p=0,541).Conclusion. An increase in the temperature regimen during the ascending aortic hemiarch replacement performed under hypothermic circulatory arrest is relatively safe in relation to early postoperative complications. Mild hypothermia does not increase early postoperative surgical risks compared to moderate hypothermia.

scholarly journals Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

2020 ◽  
Vol 25 (10) ◽  
pp. 3887
Author(s):  
B. N. Kozlov ◽  
D. S. Panfilov ◽  
E. L. Sonduev ◽  
V. L. Lukinov
Keyword(s):  
Myocardial Infarction ◽  
Aortic Aneurysm ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Ascending Aortic Aneurysm ◽  
Aortic Replacement ◽  
Prolonged Ventilation ◽  
Ascending Aortic Replacement ◽  
Hemiarch Replacement

Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

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