1
|
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.
Collapse
|
2
|
Ueda T, Hayashi H, Ando T, Iwata K, Saito H, Kumita SI. Computed Tomography Attenuation Values of the High-Attenuating Crescent Sign Can Discriminate Between Rupture, Impending Rupture, and Non-Rupture of Aortic Aneurysms. Circ J 2021; 85:2184-2190. [PMID: 34707030 DOI: 10.1253/circj.cj-21-0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although the high-attenuating crescent (HAC) sign can indicate aortic aneurysm (AA) impending rupture, the relation of its computed tomography (CT) value to the aneurysmal status remains unclear. This study compared the HAC sign CT-attenuation values among rupture, impending rupture, and non-rupture AA cases.Methods and Results:This included 76 patients (mean age: 77.0 years) diagnosed with HAC sign-associated AA between January 2005 and July 2015. The CT-attenuation values of the HAC sign (H) and aortic lumen (A) using region-of-interest methodology were measured and the H/A ratio was calculated. The study classified patients into the rupture group (R-G, n=36), impending rupture group (IR-G, n=16), and non-rupture group (NR-G, n=24); the H and the H/A ratio were compared among them. Additionally, the H and the H/A ratio cut-offs between the IR-G and NR-G groups were evaluated. The H and the H/A ratio were significantly higher in the R-G and IR-G than in the NR-G (both P<0.001); the H/A ratio was significantly higher in the R-G than in the IR-G (P=0.038). The optimal cut-off for H between the IR-G and NR-G was 50.3 Hounsfield units (area under the curve [AUC]=0.875; sensitivity=87.5%; specificity=87.5%), and that for the H/A ratio was 1.3 (AUC=0.909; sensitivity=91.7%; specificity=87.5%). CONCLUSIONS Among patients with AA, the H and the H/A ratio were significantly higher in cases of rupture and impending rupture than in those of non-rupture.
Collapse
Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School Hospital
| | | | - Takahiro Ando
- Department of Radiology, Nippon Medical School Hospital
| | - Kotomi Iwata
- Department of Radiology, Nippon Medical School Hospital
| | | | | |
Collapse
|
3
|
Antunes BFF, Tachibana A, Mendes CDA, Lembrança L, Silva MJ, Teivelis MP, Wolosker N. Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients. Clinics (Sao Paulo) 2021; 76:e2455. [PMID: 33681945 PMCID: PMC7920398 DOI: 10.6061/clinics/2021/e2455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.
Collapse
Affiliation(s)
- Bruno Fabricio Feio Antunes
- Departamento de Cirurgia Vascular, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Adriano Tachibana
- Departamento de Radiologia, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - Lucas Lembrança
- Departamento de Cirurgia Vascular, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Marcela Juliano Silva
- Departamento de Cirurgia Vascular, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - Nelson Wolosker
- Departamento de Cirurgia Vascular, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| |
Collapse
|
4
|
Durojaye M, Adeniyi T, Alagbe O. MULTIPLE SACCULAR ANEURYSMS OF THE ABDOMINAL AORTA: A CASE REPORT AND SHORT REVIEW OF RISK FACTORS FOR RUPTURE ON CT SCAN. Ann Ib Postgrad Med 2020; 18:178-180. [PMID: 34421461 PMCID: PMC8369396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Saccular abdominal aortic aneurysms (SAAA) are rare types of abdominal aortic aneurysm. It has a higher risk of rupture, hence must be repaired at smaller diameter. Mortality from rupture of an abdominal aortic aneurysm is high and has been reported to be about 90%. CASE PRESENTATION This is the case of a 37-year-old woman with chronic waist pain and abdominal discomfort. Clinical examinations revealed a pulsating abdominal mass. Doppler ultrasound and abdominopelvic contrast enhanced CT scan showed multiple saccular aneurysms of the infrarenal abdominal aorta. This patient had no identified predisposing factor. She was being worked up for surgery, but eventually died of rupture, the most dreaded complication 3 days prior to surgical repair. CONCLUSION The risk factors for rupture found in this patient were the size and type (saccular) of the aneurysm, intraluminal thrombus in addition to the multiplicity of the aneurysm as well as their adjacent positions; that probably led to arterial wall stress.
Collapse
Affiliation(s)
- M.S. Durojaye
- Department of Radiology, Union Diagnostics & Clinical Services Plc, Lagos, Nigeria.
| | - T.O. Adeniyi
- Department of Radiology, LAUTECH Teaching Hospital, Osogbo, Nigeria.
| | - O.A. Alagbe
- Department of Radiology, LAUTECH Teaching Hospital, Osogbo, Nigeria.
| |
Collapse
|
6
|
Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017; 89:218-235. [PMID: 28529185 DOI: 10.1016/j.jclinepi.2017.04.026] [Citation(s) in RCA: 758] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines, and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 2011-2012, a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages. OBJECTIVES This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports. ARTICLE DESIGN AND SETTING Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers. RESULTS AND CONCLUSION This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network [www.equator-network.org], are resources for improving the completeness and transparency of case reports.
Collapse
Affiliation(s)
- David S Riley
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA; Helfgott Research Institute, 2220 SW 1st Ave, Portland, OR 97201, USA.
| | - Melissa S Barber
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA
| | - Gunver S Kienle
- Senior Research Scientist, University of Freiburg, Fahnenbergplatz, 79085 Freiburg im Breisgau, Germany; Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Jeffrey K Aronson
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Tido von Schoen-Angerer
- Department of Pediatrics, Centre médical de La Chapelle, Chemin de Compostelle 7, 1212 Grand-Lancy, Genève, Switzerland; ACIM Institute, Filderklinik, Im Haberschlai 7, 70794 Filderstadt-Bonlanden, Germany
| | - Peter Tugwell
- Department of Medicine University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada K1H 8M5
| | - Helmut Kiene
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Mark Helfand
- Departmenty of Medical Informatics and C linical Epidemiology, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Douglas G Altman
- University of Oxford, Center for Statistics - Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Harold Sox
- Professor Medicine and of The Dartmouth Institute, Geisel School of Medicine at Dartmouth, 31 Faraway Lane, West Lebanon, NH 03784-4401, USA
| | - Paul G Werthmann
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - David Moher
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Richard A Rison
- PIH Health Hospital-Whittier, Neurology Consultants Medicine Group, University of Southern California Keck School of Medicine, 12291 Washington Blvd # 303, Whittier, CA 90606, USA
| | - Larissa Shamseer
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Christian A Koch
- Professor of Medicine, Director - Endocrinology at the University of Mississippi Medical Center, 2500 N. State Street, Jacson, MS 39216, USA
| | - Gordon H Sun
- Medical Director of Inpatient Services at Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA
| | - Patrick Hanaway
- Cener for Functional Medicine, Cleveland Clinic, Mail Code H-18, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Nancy L Sudak
- Essentia Health - Duluth, 420 East First Street, Duluth, MN 55805-1951, USA
| | | | - James E Carpenter
- Department Chair, Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA; Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| |
Collapse
|