146 lines
11 KiB
Markdown
146 lines
11 KiB
Markdown
---
|
|
title: "Dilatation of Thoracic Aorta"
|
|
docid: "3b177a9c-04f3-4d15-9d18-decc5c236e7e"
|
|
authors:
|
|
- key: "c4c34d93-63f8-4d7e-93b2-9a7232b87ec6"
|
|
value: "John P. Lichtenberger, III, MD"
|
|
breadcrumbs:
|
|
-
|
|
name: "Chest"
|
|
slug: "chest"
|
|
treeNodeId: "23b17a2b-c629-4f3b-b960-0bfdc5d138ca"
|
|
-
|
|
name: "Differential Diagnosis"
|
|
slug: "differential-diagnosis"
|
|
treeNodeId: "41e2b114-bb5b-4430-86a8-4c667ef0f50a"
|
|
-
|
|
name: "Thoracic Aorta"
|
|
slug: "thoracic-aorta"
|
|
treeNodeId: "595e605a-6053-4b51-9848-2d0aed1b9299"
|
|
-
|
|
name: "General Imaging Patterns"
|
|
slug: "general-imaging-patterns"
|
|
treeNodeId: "f7c484b2-c364-43b7-ac6b-82d2f0444c3e"
|
|
-
|
|
name: "Dilatation of Thoracic Aorta"
|
|
slug: "dilatation-of-thoracic-aorta"
|
|
treeNodeId: null
|
|
category: "Chest"
|
|
cmeTopicId: "b38d09b5-ad4e-4ebc-b077-20db7f4c0371"
|
|
documentVersionId: "2cc5bdb2-db16-482c-aca6-0ffc420779dd"
|
|
imageCount: 8
|
|
lastUpdated: "02/10/20"
|
|
pageDescription: "Dilatation of Thoracic Aorta"
|
|
pageKeywords: "Chest, Differential Diagnosis, Thoracic Aorta, General Imaging Patterns, Dilatation of Thoracic Aorta"
|
|
pageTitle: "Dilatation of Thoracic Aorta | STATdx"
|
|
enhancedTitle: "Dilatation of Thoracic Aorta"
|
|
type: "DDX"
|
|
references: true
|
|
breadcrumbs:
|
|
- "Chest"
|
|
- "Differential Diagnosis"
|
|
- "Thoracic Aorta"
|
|
- "General Imaging Patterns"
|
|
- "Dilatation of Thoracic Aorta"
|
|
---
|
|
# ESSENTIAL INFORMATION
|
|
|
|
- ## Key Differential Diagnosis Issues
|
|
|
|
|
|
- Ascending aorta dilated ≥ 4.0 cm, aneurysmal ≥ 5.0 cm
|
|
- Descending thoracic aorta aneurysmal ≥ 4.0 cm
|
|
- ## Helpful Clues for Common Diagnoses
|
|
|
|
|
|
- **Atherosclerotic Aneurysm**
|
|
- Fusiform aortic aneurysms most common
|
|
- Typically arise from ascending aorta
|
|
- Dilation of aorta typically in presence of significant atherosclerotic disease
|
|
- Commonly contain thrombus
|
|
- Saccular aneurysms have increased risk of rupture
|
|
- **Penetrating Atherosclerotic Ulcer**
|
|
- Focal contrast-filled outpouching of aortic wall; underlying atherosclerotic disease
|
|
- More common in descending aorta or aortic arch
|
|
- Associated with intramural hematoma, aortic dissection
|
|
- Vast majority of patients have underlying hypertension and history of smoking
|
|
- ## Helpful Clues for Less Common Diagnoses
|
|
|
|
|
|
- **Ductus Diverticulum**
|
|
- Focal outpouching along anterior wall at aortic isthmus
|
|
- Smooth angles, obtuse shoulders
|
|
- Sagittal images may show diverticulum contiguous with ligamentum arteriosum
|
|
- May contain thrombus and wall calcification
|
|
- **Traumatic Pseudoaneurysm**
|
|
- Most common location is aortic isthmus (may also be seen at aortic root or diaphragmatic hiatus)
|
|
- Focal contrast-filled outpouching along undersurface of aortic arch/anterior wall of aortic isthmus
|
|
- Unlike ductus diverticulum, traumatic pseudoaneurysms have sharp angles, irregular margins, and possible visible intimal flap
|
|
- Associated mediastinal hematoma may be present
|
|
- **Postoperative Pseudoaneurysm**
|
|
- Contrast-filled outpouching beyond walls of aorta associated with surgical changes
|
|
- Commonly seen with aortic valve replacement (especially in cases of endocarditis) and graft repair
|
|
- Noncontrast imaging useful to detect high-attenuation surgical material mimicking pseudoaneurysm
|
|
- ## Helpful Clues for Rare Diagnoses
|
|
|
|
|
|
- **Aortitis**
|
|
- Most commonly involve thoracic aorta: Takayasu and giant cell arteritis
|
|
- Leads to wall thickening, irregular aortic contours, aneurysm formation, and narrowing/occlusion
|
|
- Aneurysm may be fusiform or saccular
|
|
- Calcification may be present in chronic cases
|
|
- MR findings
|
|
- Thickened walls with high signal intensity on T2WI
|
|
- Enhancement of arterial wall
|
|
- Mycotic aortitis may cause dilation
|
|
- Hematogenous spread of organisms (*Staphylococcus aureus* and *Salmonella* species most common)
|
|
|
|
## References
|
|
|
|
# Selected References
|
|
|
|
1. [Saremi F et al: Image predictors of treatment outcome after thoracic aortic dissection repair. Radiographics. 38(7):1949-72, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=30312138%5Bpmid%5D)
|
|
|
|
|
|
## Images
|
|
|
|
|
|
### Selected Images
|
|
|
|
|
|
**Atherosclerotic Aneurysm**
|
|
*PA chest radiograph shows dilation of the thoracic aorta, evidenced by abnormal contour of the aortic arch <img src='img/arrows/CS.png'/> and displacement of the intrathoracic trachea to the right <img src='img/arrows/CC.png'/>. The ascending aorta <img src='img/arrows/CO.png'/> is visible overlying the right hilum.*
|
|
|
|
|
|
**Atherosclerotic Aneurysm**
|
|
*PA chest radiograph shows dilation of the thoracic aorta, evidenced by abnormal contour of the aortic arch <img src='img/arrows/CS.png'/> and displacement of the intrathoracic trachea to the right <img src='img/arrows/CC.png'/>. The ascending aorta <img src='img/arrows/CO.png'/> is visible overlying the right hilum.*
|
|
|
|
|
|
**Atherosclerotic Aneurysm**
|
|
*Axial CECT of the same patient shows aneurysm of the descending thoracic aorta <img src='img/arrows/CS.png'/> and calcified <img src='img/arrows/CC.png'/> and noncalcified atherosclerotic disease of the aorta. Atherosclerosis is the most common cause of aortic dilation.*
|
|
|
|
|
|
**Traumatic Pseudoaneurysm**
|
|
*Double oblique MRA of the thoracic aorta in a patient with a history of thoracic trauma shows a saccular aneurysm <img src='img/arrows/CS.png'/> of the aortic arch. Acute angles of the aneurysm <img src='img/arrows/CC.png'/> differentiate this pseudoaneurysm from a ductus diverticulum.*
|
|
|
|
|
|
**Traumatic Pseudoaneurysm**
|
|
*Composite image with axial CECT (left) and NECT (right) shows focal dilation of the ascending aorta with high attenuation in the expected location of the medial aortic wall <img src='img/arrows/CO.png'/> representing postsurgical material <img src='img/arrows/CC.png'/> rather than aortic pathology.*
|
|
|
|
|
|
**Postoperative Pseudoaneurysm**
|
|
*PA chest radiograph of a patient with a history of bicuspid aortic valve and coarctation status post stent placement in the proximal descending thoracic aorta shows new dilation of the aortic arch and descending aorta <img src='img/arrows/CS.png'/>. The intrathoracic trachea is displaced to the right <img src='img/arrows/CC.png'/>.*
|
|
|
|
|
|
**Postoperative Pseudoaneurysm**
|
|
*Coronal reformatted CECT of the same patient shows the descending thoracic aortic stent <img src='img/arrows/CC.png'/> complicated by large, complex contrast outpouchings <img src='img/arrows/CS.png'/>, consistent with postoperative pseudoaneurysms.*
|
|
|
|
|
|
**Aortitis**
|
|
*Axial CECT of a patient with sepsis and chest pain shows aneurysmal dilation of the proximal descending thoracic aorta <img src='img/arrows/CS.png'/> with associated diffuse aortic wall thickening and enhancement <img src='img/arrows/CC.png'/>, consistent with infectious aortitis.*
|
|
|
|
|
|
**Aortitis**
|
|
*Fused coronal reformatted FDG PET/CT of the same patient shows diffuse FDG avidity of the thickened, aneurysmal descending thoracic aorta <img src='img/arrows/CS.png'/>. A large left pleural effusion is also present. Staphylococcus and salmonella are frequent organisms causing infectious aortitis.*
|
|
|