Duplication of abdominal aorta: a very rare congenital anomaly but a common ultrasound artifact

Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations

Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.

Double aorta artifact in sonography - a diagnostic challenge

The double aorta artifact was described and studied thoroughly twenty-five years ago. Despite this, it is still not commonly known today and can cause diagnostic difficulty. Total aortic duplication can be considered an anatomic defect whilst partial duplication mimics aortic dissection. In the literature, this artifact has been compared with a very rare anomaly, i.e. the occurrence of two aortas in one patient. Currently, however, the differentiation of this artifact from abdominal aortic dissection seems to be of greater significance. The double aorta image occurs when ultrasound waves encounter prismatic fat tissue of the anterior abdominal wall. This artifact is more frequently observed in children and athletic young adults since the structure of this anatomic region in these individuals is conductive to the occurrence of this phenomenon. Moreover, it can be observed more often when curved transducers are used. Due to all these factors, an ultrasound beam undergoes greater refraction and make the artifact clearer. This phenomenon is usually easily recognizable and avoidable, but it sometimes might cause diagnostic difficulty. Obtaining an image of double abdominal vessels on ultrasound examination in transverse sections requires further inspection of the aorta in a different (sagittal) plane. This is not always possible due to poor patient preparation for scanning. Symmetrical flow on Doppler sonography is a typical feature of this artifact. Finally, magnetic resonance imaging or computed tomography can be considered to rule out a pathology.

Pseudothrombus of the Aorta

The purpose of this study is to demonstrate a common ultrasound artifact of the abdominal aorta in pediatric patients through a retrospective analysis of 150 consecutive pediatric abdominal ultrasound examinations. The presence of an aortic pseudomass was evaluated at the level of the celiac trunk and superior mesenteric artery (SMA). An artifact within the aorta at the level of the SMA was noted in 39 patients (26%) and an artifact at the level of the celiac trunk was noted in 4 patient (3%). In 7 of 8 cases the artifact at the level of the SMA was eliminated by use of the Clarify™ Vascular Enhancement (VE) Technology. A pseudomass of the aorta is a common artifact in pediatric abdominal ultrasound examinations. Changing the position of the transducer or utilizing the Clarify Vascular Enhancement Technology may help differentiate between a pseudomass and a thrombus and prevent further costly diagnostic work-up.