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Giugno L, Formato GM, Chessa M, Votta E, Carminati M, Sturla F. Case report: Personalized transcatheter approach to mid-aortic syndrome by in vitro simulation on a 3-dimensional printed model. Front Cardiovasc Med 2023; 9:1076359. [PMID: 36704466 PMCID: PMC9871590 DOI: 10.3389/fcvm.2022.1076359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
An 8-year-old girl, diagnosed with mid-aortic syndrome (MAS) at the age of 2 months and under antihypertensive therapy, presented with severe systemic hypertension (>200/120 mmHg). Computed tomography (CT) examination revealed aortic aneurysm between severe stenoses at pre- and infra-renal segments, and occlusion of principal splanchnic arteries with peripheral collateral revascularization. Based on CT imaging, preoperative three-dimensional (3D) anatomy was reconstructed to assess aortic dimensions and a dedicated in vitro planning platform was designed to investigate the feasibility of a stenting procedure under fluoroscopic guidance. The in vitro system was designed to incorporate a translucent flexible 3D-printed patient-specific model filled with saline. A covered 8-zig 45-mm-long Cheatham-Platinum (CP) stent and a bare 8-zig, 34-mm-long CP stent were implanted with partial overlap to treat the stenoses (global peak-to-peak pressure gradient > 60 mmHg), excluding the aneurysm and avoiding risk of renal arteries occlusion. Percutaneous procedure was successfully performed with no residual pressure gradient and exactly replicating the strategy tested in vitro. Also, as investigated on the 3D-printed model, additional angioplasty was feasible across the frames of the stent to improve bilateral renal flow. Postoperative systemic pressure significantly reduced (130/70 mmHg) as well as dosage of antihypertensive therapy. This is the first report demonstrating the use of a 3D-printed model to effectively plan percutaneous intervention in a complex pediatric MAS case: taking full advantage of the combined use of a patient-specific 3D model and a dedicated in vitro platform, feasibility of the stenting procedure was successfully tested during pre-procedural assessment. Hence, use of patient-specific 3D-printed models and in vitro dedicated platforms is encouraged to assist pre-procedural planning and personalize treatment, thus enhancing intervention success.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Maria Formato
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Facoltà di Medicina e Chirurgia, Vita Salute San Raffaele University, Milan, Italy,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, Netherlands
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy,*Correspondence: Francesco Sturla ✉
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2
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Pierro A, Posa A, Iorio L, Tanzilli A, Cucciolillo L, Quinto F, Sciandra M, Iezzi R, Cilla S. Bib Sign in Proximal Descending Thoracic Aorta Rupture on CT Angiography: Presentation of a Paradigmatic Case. Case Rep Radiol 2022; 2022:6947207. [PMID: 36518096 PMCID: PMC9744601 DOI: 10.1155/2022/6947207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 08/30/2023] Open
Abstract
Thoracic aortic rupture may present with subtle clinical and CT-angiography findings. Recognition of the imaging features of early rupture is key for timely diagnosis and treatment. This report presents a new sign of incipient proximal thoracic aortic rupture on CT-angiography.
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Affiliation(s)
- Antonio Pierro
- Radiology Department, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Alessandro Posa
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Luca Iorio
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, “A. Gemelli” University Hospital, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Alessandro Tanzilli
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Lucia Cucciolillo
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, “A. Gemelli” University Hospital, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Fabio Quinto
- Ospedale L. Bonomo, Viale Istria, 76123 Andria, Italy
| | - Mariacarmela Sciandra
- Radiology Department, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Roberto Iezzi
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, L.go A. Gemelli, 1, 86100 Campobasso, Italy
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3
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Park H, Shin TG, Kim WY, Jo YH, Hwang YJ, Choi SH, Lim TH, Hna KS, Shin J, Suh GJ, Kang GH, Kim KS, Korean Shock Society investigators. Current updates in acute traumatic aortic injury: radiologic diagnosis and management. Clin Exp Emerg Med 2022; 9:73-83. [PMID: 35843607 PMCID: PMC9288877 DOI: 10.15441/ceem.22.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
Acute traumatic aortic injuries, which have substantial lethal outcomes at the time of admission, are fatal in 80% to 90% of cases. These injuries are relatively rare and have nonspecific clinical presentations. Radiologists and emergency physicians need to identify the radiological signs of acute traumatic aortic injury and differentiate them from common imaging errors to ensure accurate diagnosis and determine appropriate management protocols. In combination with image-guided interventions, advances in cross-sectional imaging have enabled nonsurgical management of acute traumatic aortic injuries. Timely and precise diagnoses of these injuries following prompt treatment are essential as up to 90% of patients presenting at the hospital can undergo early repair.
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4
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MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal. Tomography 2022; 8:200-228. [PMID: 35076599 PMCID: PMC8788571 DOI: 10.3390/tomography8010017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.
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5
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Lyonga Ngonge A, Ganta N, Jalal Eldin A, Effoe V, Nso N, Williams D. The Dilemma in the Management of Thromboembolic Disease in the Setting of Concomitant Aortic Pseudoaneurysm. Cureus 2021; 13:e20668. [PMID: 35106211 PMCID: PMC8786573 DOI: 10.7759/cureus.20668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Ascending aortic pseudoaneurysm (AAP) is a rare and serious complication of cardiothoracic surgeries or blunt chest trauma. We present a patient with paroxysmal atrial fibrillation, acute right pontine stroke, and acute pulmonary embolism (PE) with an incidental AAP that precluded the use of anticoagulation and surgery. The case findings substantiate the need for a CT-based assessment of aortic pathology after coronary artery bypass grafting (CABG) in the asymptomatic patient to determine the most appropriate treatment modalities. However, the high cost of CT imaging and the potential radiation exposure challenge its routine use in high-risk patients.
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6
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Distinguishing acute from chronic aortic dissections using CT imaging features. Int J Cardiovasc Imaging 2018; 34:1831-1840. [PMID: 29915877 DOI: 10.1007/s10554-018-1398-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/13/2018] [Indexed: 10/14/2022]
Abstract
The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 patients were reviewed for a variety of imaging features. Statistical tests assessed for differences in the frequency of these features. A predictive model was created and tested on an additional 120 CT scans from 115 patients. Statistically significant features of AAD included periaortic confluent soft tissue opacity, curved dissection flap, and highly mobile dissection flap, and features of CAD included thick dissection flap, false lumen (FL) outer wall calcification, FL thrombus, dilated FL, and tear edges curling into the FL. The model predicted the chronicity of a dissection with an area under the curve of 0.98 (CI 0.98-1.00). AADs and CADs demonstrated significantly different CT imaging features.
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7
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Rafailidis V, Partovi S, Dikkes A, Nakamoto DA, Azar N, Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc Diagn Ther 2018; 8:S118-S130. [PMID: 29850424 DOI: 10.21037/cdt.2017.09.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease. Interventional angiography is currently primarily performed for treatment purposes of aortic pathology. The introduction of microbubbles as ultrasonographic contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving valuable complementary technique with markedly increased diagnostic accuracy for certain aortic applications. CEUS is characterized by the potential to be performed in patients with impaired renal function. Due to its superior spatial and temporal resolution, ability for prolonged scanning and dynamic and real-time imaging, it provides clinically significant additional information compared to the standard Duplex US. The purpose of this paper is to discuss the currently available literature regarding abdominal aortic applications of CEUS, briefly elaborate on CEUS technique and safety and present cases in order to illustrate the added value in aortic pathologies. Conditions discussed include abdominal aortic aneurysm (AAA), aneurysm rupture, aneurysm surveillance after endovascular repair, dissection and aortitis.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sasan Partovi
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander Dikkes
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dean A Nakamoto
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel Staub
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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8
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Awais M, Rehman A, Baloch NU. Multiplanar Computed Tomography of Vascular Etiologies of Acute Abdomen: A Pictorial Review. Cureus 2018; 10:e2393. [PMID: 29850388 PMCID: PMC5973495 DOI: 10.7759/cureus.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute abdomen is a common presentation in the emergency department and radiologic imaging plays a pivotal role in the evaluation of such patients. Multi-detector computed tomography (MDCT) is the most commonly utilized radiologic investigation in such patients as it can be performed fairly rapidly and has excellent accuracy for diagnosing various causes of an acute abdomen. Additionally, MDCT may also reveal clues towards an alternative diagnosis that was not even suspected on the basis of a history and physical examination. Consequently, it is indispensable for radiologists to be able to accurately and efficiently recognize imaging features of disorders that may present as an acute abdomen. While gastrointestinal, hepatobiliary and genitourinary causes account for most cases of acute abdomen, vascular etiologies may also be implicated in a small-but significant-proportion of cases. Therefore, in this pictorial review, we describe the typical MDCT imaging features of various vascular etiologies that may present as an acute abdomen.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Abdul Rehman
- Department of Medicine, Hamad Medical Corporation
| | - Noor U Baloch
- Department of Medicine, Rutgers New Jersey Medical School
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9
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Li PS, Tsai CL, Hu SY, Lin TC, Chang YT. Spontaneous hemothorax caused by ruptured multiple mycotic aortic aneurysms: a case report and literature review. J Cardiothorac Surg 2017; 12:109. [PMID: 29197388 PMCID: PMC5712197 DOI: 10.1186/s13019-017-0665-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Mycotic aortic aneurysm (MAA) is a rare clinical entity with an incidence of 1-3%, but it is a life-threatening infection of aorta characterized by dilatation of aorta with false lumen. Multiple MAAs have been reported rarely with an incidence of 0.03% and associated with a high mortality rate of 80% if ruptured. Case presentation A hypertensive and diabetic 78-year-old man visited our emergency department complaining intermittent dull and tingled pain over the left flank region for 1 week. Chest X-ray showed left pleural effusion and hemothorax was confirmed by thoracocentesis. Computed tomography (CT) of chest demonstrated multiple thoracic aortic aneurysms and the pathological findings disclosed the diagnosis of multiple MAAs. He was discharged under an uneventful condition post-surgical aortic repair with adequate intravenous antibiotics for 4 weeks. Conclusions CT scan may make a definite diagnosis of multiple MAAs and management with surgical debridement, aortic repair and full-course antibiotics for Gram-positive coccus and/or Gram-negative bacillus is recommended.
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Affiliation(s)
- Po-Sung Li
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Lin Tsai
- Division of Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan. .,Department of Nursing, Central Taiwan Univeristy of Science and Technology, Taichung, Taiwan. .,, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan
| | - Yao-Tien Chang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
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10
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Nagpal P, Mullan BF, Sen I, Saboo SS, Khandelwal A. Advances in Imaging and Management Trends of Traumatic Aortic Injuries. Cardiovasc Intervent Radiol 2017; 40:643-654. [DOI: 10.1007/s00270-017-1572-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/02/2017] [Indexed: 01/16/2023]
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11
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Multidetector CT evaluation of alternative diagnosis of clinically suspected acute appendicitis, appendicular and nonappendicular lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Reginelli A, Capasso R, Ciccone V, Croce MR, Di Grezia G, Carbone M, Maggialetti N, Barile A, Fonio P, Scialpi M, Brunese L. Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak. Int J Surg 2016; 33 Suppl 1:S76-84. [DOI: 10.1016/j.ijsu.2016.05.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Ciccone MM, Dentamaro I, Masi F, Carbonara S, Ricci G. Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques. Vasc Med 2016; 21:239-50. [DOI: 10.1177/1358863x16631419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic diseases include a wide range of pathological conditions: aortic aneurysms, pseudoaneurysms, acute aortic syndromes, atherosclerotic and inflammatory conditions, genetic diseases and congenital anomalies. Acute aortic syndromes have acute onset and may be life-threatening. They include aortic dissection, intramural haematoma, penetrating aortic ulcer and traumatic aortic injury. Pain is the common denominator to all acute aortic syndromes. Pain occurs regardless of age, gender and other associated clinical conditions. In this review, we deal with the main findings in the clinical setting and the most recent indications for diagnostic imaging, which are aimed to start an appropriate treatment and improve the short- and long-term prognosis of these patients.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Ilaria Dentamaro
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Filippo Masi
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Santa Carbonara
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Gabriella Ricci
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
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14
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Iacobellis F, Ierardi AM, Mazzei MA, Magenta Biasina A, Carrafiello G, Nicola R, Scaglione M. Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications. Br J Radiol 2016; 89:20150952. [PMID: 26882960 DOI: 10.1259/bjr.20150952] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.
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Affiliation(s)
- Francesca Iacobellis
- 1 Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy.,2 Department of Radiology, Second University of Naples, Naples, Italy
| | - Anna M Ierardi
- 3 Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Maria A Mazzei
- 4 Department of Surgical Sciences, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Gianpaolo Carrafiello
- 3 Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Refky Nicola
- 6 Division of Emergency Imaging, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mariano Scaglione
- 1 Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy.,7 Department of Radiology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
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15
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Crucial role of carotid ultrasound for the rapid diagnosis of hyperacute aortic dissection complicated by cerebral infarction: A case report and literature review. Medicina (B Aires) 2016; 52:378-388. [DOI: 10.1016/j.medici.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/14/2016] [Accepted: 11/08/2016] [Indexed: 01/16/2023] Open
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16
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Hammer S, Kroft LJ, Hidalgo AL, Leta R, de Roos A. Chest CT examinations in patients presenting with acute chest pain: a pictorial review. Insights Imaging 2015; 6:719-28. [PMID: 26373647 PMCID: PMC4656238 DOI: 10.1007/s13244-015-0429-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/28/2015] [Accepted: 09/03/2015] [Indexed: 12/01/2022] Open
Abstract
Acute chest pain (ACP) is one of the most common presenting symptoms at the emergency department. The differential diagnosis is vast. To exclude life-threatening causes, radiologists encounter an increasing amount of thoracic computed tomography (CT) examinations including CT angiography of the heart and great vessels. The dual- and triple-rule CT examinations are currently implemented in clinical practice. We retrospectively identified chest CT examinations in the setting of acute chest pain in our hospitals and collected a variety of common and uncommon cases. In this pictorial essay, we present the most educative cases from patients who presented with acute chest pain in the emergency department of our hospitals and for whom a thoracic CT was ordered. When aortic emergencies, acute coronary syndrome, and pulmonary embolism are excluded, these cases may help the radiologist to suggest alternative diagnoses in the diagnostic challenge of acute chest pain. Teaching Points • The number of chest CT examinations for ACP is increasing. • Chest CT examinations may help suggesting alternative diagnosis in ACP. • Radiologists should be aware of the differential diagnosis of ACP.
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Affiliation(s)
- Sebastiaan Hammer
- Department of Radiology, C2-S, Leiden University Medical Centre, Albinusdreef 2a, 2333 ZA, Leiden, The Netherlands.
| | - Lucia J Kroft
- Department of Radiology, C2-S, Leiden University Medical Centre, Albinusdreef 2a, 2333 ZA, Leiden, The Netherlands
| | - Alberto L Hidalgo
- Cardiac Imaging Unit, Hospital de la Santa Creu i Sant Pau, Clínica Creu Blanca, Universitat Autònoma de Barcelona, Reina Elisenda de Montcada 17, Barcelona, 08034, Spain
| | - Ruben Leta
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Clínica Creu Blanca, Universitat Autònoma de Barcelona, Reina Elisenda de Montcada 17, Barcelona, 08034, Spain
| | - Albert de Roos
- Department of Radiology, C2-S, Leiden University Medical Centre, Albinusdreef 2a, 2333 ZA, Leiden, The Netherlands
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17
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Mokrane FZ, Revel-Mouroz P, Saint Lebes B, Rousseau H. Traumatic injuries of the thoracic aorta: The role of imaging in diagnosis and treatment. Diagn Interv Imaging 2015; 96:693-706. [PMID: 26122129 DOI: 10.1016/j.diii.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
Traumatic injury of the thoracic aorta remains the leading cause of death in multiple trauma patients and it requires urgent management. Computed tomography has a key diagnostic role and allows the clinician to choose an appropriate treatment strategy. The development of new classifications, based on a better understanding of the mechanisms of these injuries, has clarified the indications for treatment. Advances in techniques, especially in endovascular management, have contributed to improving prognosis for patients. Interventional radiology, which usually consists of endovascular placement of a covered stent, now constitutes the gold standard treatment in these injuries. Due to the potentially grave prognosis of these patients, it is crucial to know how to detect these injuries and to describe the imaging signs of serious damage.
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Affiliation(s)
- F Z Mokrane
- Department of Radiology, CHU Rangueil Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| | - P Revel-Mouroz
- Department of Radiology, CHU Rangueil Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - B Saint Lebes
- Department of Vascular Surgery, CHU Rangueil Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - H Rousseau
- Department of Radiology, CHU Rangueil Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
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