scholarly journals Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls

2021 ◽  
pp. 084653712110015 ◽  
Author(s):  
Mana Modares ◽  
Kate Hanneman ◽  
Maral Ouzounian ◽  
Jennifer Chung ◽  
Elsie T. Nguyen
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Prognostic Significance ◽  
Intramural Hematoma ◽  
Classification Systems ◽  
Imaging Features ◽  
Management Options ◽  
Acute Aortic Syndromes ◽  
Threatening Condition ◽  
Life Threatening

An acute aortic syndrome (AAS) is an important life-threatening condition that requires early detection and management. Acute intramural hematoma (IMH), aortic dissection (AD) and penetrating atherosclerotic ulcer (PAU) are included in AAS. ADs can be classified using the well-known Stanford or DeBakey classification systems. However, these classification systems omit description of arch dissections, anatomic variants, and morphologic features that impact outcome. The Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) have recently introduced a classification system that classifies ADs according to the location of the entry tear (primary intimomedial tear, PIT) and the proximal and distal extent of involvement, but does not include description of all morphologic features that may have diagnostic and prognostic significance. This review describes these classification systems for ADs and other AAS entities as well as their limitations. Typical computed tomography angiography (CTA) imaging appearance and differentiating features of ADs, limited intimal tears (LITs), IMHs, intramural blood pools (IBPs), ulcer-like projections (ULPs), and PAUs will be discussed. Furthermore, this review highlights common imaging interpretation pitfalls, what should be included in a comprehensive CTA report, and provides a brief overview of current management options.

scholarly journals Computed Tomography Angiography under Deep Learning in the Treatment of Atherosclerosis with Rapamycin

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fuguang Ji ◽  
Shuai Zhou ◽  
Zhangshuan Bi
Keyword(s):  
Computed Tomography ◽  
Deep Learning ◽  
Computed Tomography Angiography ◽  
Atherosclerotic Lesion ◽  
Region Of Interest ◽  
Left Ventricular ◽  
Dice Similarity Coefficient ◽  
Imaging Features ◽  
Lesion Area ◽  
Imaging Characteristics

The clinical characteristics and vascular computed tomography (CT) imaging characteristics of patients were explored so as to assist clinicians in diagnosing patients with atherosclerosis. 316 patients with atherosclerosis who were hospitalized for emergency treatment were treated with rapamycin (RAPA) in the hospital. A group of manually delineated left ventricular myocardia (LVM) on the patient’s coronary computed tomography angiography (CCTA) were selected as the region of interest for imaging features extracted. The CCTA images of 80% of patients were randomly selected for training, and those of 20% of patients were used for verification. The correlation matrix method was used to remove redundant image omics features under different correlation thresholds. In the validation set, CCTA diagnostic parameters were about 40 times higher than the manually segmented data. The average dice similarity coefficient was 91.6%. The proposed method also produced a very small centroid distance (mean 1.058 mm, standard deviation 1.245 mm) and volume difference (mean 1.640), with a segmentation time of about 1.45 ± 0.51 s, compared to about 744.8 ± 117.49 s for physician manual segmentation. Therefore, the deep learning model effectively segmented the atherosclerotic lesion area, measured and assisted the diagnosis of future atherosclerosis clinical cases, improved medical efficiency, and accurately identified the patient’s lesion area. It had great application potential in helping diagnosis and curative effect analysis of atherosclerosis.

scholarly journals Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography

2018 ◽  
Vol 8 (5) ◽  
pp. 467-475 ◽  
Author(s):  
Marysia S Tweet ◽  
Nila J Akhtar ◽  
Sharonne N Hayes ◽  
Patricia JM Best ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Computed Tomography ◽  
Luminal Stenosis

Background: The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed. Methods: The “Virtual” Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection. Results: Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery. Conclusions: We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.

scholarly journals Computed tomography angiography findings of abdominal aortic disease: A review of emergencies

2020 ◽  
Vol 73 (11-12) ◽  
pp. 393-400
Author(s):  
Mirela Jukovic ◽  
Aleksandra Mijatovic ◽  
Ivana Stojic ◽  
Ljiljana Drazetin ◽  
Maja Stankov ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aorta ◽  
Computed Tomography Angiography ◽  
Clinical Manifestations ◽  
Aortic Disease ◽  
Occlusive Disease ◽  
Tunica Media ◽  
Abdominal Aortic ◽  
Wide Range ◽  
Life Threatening

Introduction. The aorta is a major blood vessel that supplies all segments of the human body. Acute aortic syndrome is a term that implies a life-threatening aortic disease. Due to the speed of examination and widespread availability, computed tomography angiography is a front-line diagnostic modality for emergencies and diseases of the abdominal aorta. The aim of this study was to provide a wide range of potentially life-threatening abnormalities of the abdominal aorta in daily clinical and radiological practice through a series of computed tomography angiography images and three-dimensional virtual reconstruction. Abdominal aortic aneurysm is defined as a 50% increase in diameter more than the normal arterial diameter. One of the most important complications of an aneurysm is a rupture that can be acute or chronic, presenting with various clinical manifestations. Aortic dissections are caused by abnormality of the tunica media layer, forming an intimal-medial flap and two types of lumen. A penetrating aortic ulcer may erode through the internal elastic lamina of the aortic wall and allow formation of hematoma within the tunica media. Occlusive disease of the abdominal aorta may refer to the late stage of chronic aortoiliac occlusive disease, whereas the acute and/or subacute form occurs due to sudden thrombosis or occlusion. Conclusion. The recognition of specific radiological signs of abdominal aortic disease using computed tomography angiography contributes to optimal treatment of patients and reduces mortality.

Penetrating Aortic Ulcer and Intramural Hematoma

2015 ◽  
Author(s):  
Nanette R. Reed ◽  
Gustavo S. Oderich
Keyword(s):  
Endovascular Repair ◽  
Intramural Hematoma ◽  
Computed Tomographic Angiography ◽  
Classification Systems ◽  
Penetrating Aortic Ulcer ◽  
Computed Tomographic ◽  
Disease Spectrum ◽  
Acute Aortic Syndromes ◽  
Clinical Series ◽  
Aortic Media

Acute aortic syndrome is a spectrum of three overlapping clinical and anatomic diseases: penetrating aortic ulcers, intramural hematomas, and acute aortic dissections. All three entities are part of a disease spectrum, which is characterized by a disruption of the aortic media to a varying degree. Penetrating aortic ulcer, intramural hematoma, and aortic dissection can occur as isolated processes or can be found in association. Although the clinical presentations of the three conditions overlap to some extent, the diagnosis of each specific disease is largely based on specific imaging findings. All three entities are potentially life threatening, so prompt diagnosis and treatment are of paramount importance. Risk factors include hypertension, male sex, tobacco use, atherosclerosis, previous aortic operations, catheter-based interventions, bicuspid aortic valve, and connective tissue disorders. This review summarizes the clinical presentation, diagnosis, indications for repair, and endovascular strategies in patients with acute aortic syndromes. Tables outline early and late outcomes of contemporary clinical series of endovascular repairs of penetrating aortic ulcers and intramural hematomas. Figures show the overlapping features of acute aortic syndromes, progression of penetrating aortic ulcers, a large penetrating aortic ulcer in the proximal thoracic aorta (including representations before endovascular repair and after stent graft coverage), completion angiography demonstrating the patency of chimney and thoracic stent grafts, pre- and postoperative computed tomographic angiography after endovascular repair of a complicated penetrating aortic ulcer, and the Stanford and DeBakey classification systems.  This review contains 8 figures, 4 tables, and 73 references.

Gastropericardial fistula: A rare etiology of chest pain

2017 ◽  
Vol 25 (2) ◽  
pp. 106-109
Author(s):  
Amine Ghalem ◽  
Mehdi Berrajaa ◽  
Kamal Ahsayan ◽  
Mohammed Aabdi ◽  
Imane Boutahar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Wedge Resection ◽  
Unusual Condition ◽  
Gastropericardial Fistula ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Esophagogastric Surgery

Gastropericardial fistula is an abnormal communication between the stomach and the pericardium. It is a rare, life-threatening condition that has numerous etiologies. We report the case of a 53-year-old male patient, with a history of wedge resection for gastrointestinal stromal tumor, who presented to the emergency department for epigastric and chest pain along with lethargy leading to the uncommon diagnosis of gastropericardial fistula with pneumopericardium. Through this case, we would like to draw clinicians’ attention to gastropericardial fistula as a differential diagnosis in patients presenting for epigastric and/or chest pain with a history of esophagogastric surgery, emphasizing on the key role of computed tomography in this regard, and underscore the management basics of this unusual condition.

Epidemiology of Neonatal Disorders of Respiration

1991 ◽  
Vol 7 (S1) ◽  
pp. 9-15 ◽  
Author(s):  
Ola Hjalmarson
Keyword(s):  
Respiratory Distress ◽  
Chest Wall ◽  
Prognostic Significance ◽  
Newborn Infants ◽  
Breathing Frequency ◽  
Threatening Condition ◽  
Life Threatening

It is well known that signs of respiratory distress or disease (RD), such as high breathing frequency, chest wall retractions, grunting, and cyanosis, are common in newborn infants. The signs may be very transient or develop into a potentially life-threatening condition. When they are first observed, they often have a very ambiguous prognostic significance.

scholarly journals Aortic Dissection with Rare Anatomical Aortic Arch Variation Depicted by Computed Tomography Angiography

2021 ◽  
Vol 24 (2) ◽  
pp. E407-E408
Author(s):  
Xin Wang ◽  
Bofu Liu ◽  
Haifang Yu
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Aortic Dissection ◽  
Effective Treatment ◽  
Aortic Arch ◽  
Endovascular Repair ◽  
Computed Tomography Angiography ◽  
Chest Trauma ◽  
Life Threatening ◽  
Treatment Surgery

Aortic dissection (AD) is a life-threatening disease, and endovascular repair by stent graft is an effective treatment. Surgery often fails for a variety of reasons, such as aortic arch variation. We present the case of a 27-year-old female with aortic dissection with a rare anatomical aortic arch variation caused by chest trauma. This patient recovered well after endovascular repair. This case report demonstrates endovascular repair can be applied to aortic dissection patients with rare anatomical aortic arch variation.

scholarly journals Vertebral erosion due to chronic rupture of aneurismatic abdominal aorta

2019 ◽  
Vol 147 (11-12) ◽  
pp. 762-764
Author(s):  
Nikola Colic ◽  
Dusan Saponjski ◽  
Milica Stojadinovic ◽  
Danilo Jeremic ◽  
Biljana Parapid ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Psoas Muscle ◽  
Surrounding Tissue ◽  
Arterial Phase ◽  
Lateral Part ◽  
Chronic Rupture ◽  
Threatening Condition ◽  
Life Threatening

Introduction. Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline. A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion. Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion.

scholarly journals Cervical Pregnancy: Two Cases with Different Treatment Strategies

2016 ◽  
Vol 6 (1) ◽  
pp. 51-54
Author(s):  
Hanan M. Shamrani
Keyword(s):  
Therapeutic Option ◽  
Treatment Strategies ◽  
First Trimester ◽  
Management Options ◽  
Uterine Preservation ◽  
Cervical Pregnancy ◽  
Dilatation And Curettage ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening

Cervical pregnancy is a rare, potentially life-threatening condition that presents challenging management options. We report the cases of two patients: a 38-year-old, gravida 11 para 8+ 2 who presented with first-trimester vaginal bleeding and a 32-year-old female primigravida who presented in her ninth week of gestation with vaginal spotting and abdominal pain. Radiological and histopathological findings were consistent with cervical pregnancy in both cases, which were managed successfully with different approaches. Conservative management with intra-embryonic injection of potassium chloride was successful in the first case while dilatation and curettage after intramuscular methotrexate administration resolved the second patient's symptoms. Cervical pregnancy, when diagnosed early, can be successfully treated with medical therapy. Surgical intervention may be necessary, but adopting medical treatment as a first-line therapeutic option offers the advantage of uterine preservation.

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