127 lines
13 KiB
Markdown
127 lines
13 KiB
Markdown
---
|
|
title: "Dolichoectasia"
|
|
docid: "31d50b93-b057-4da3-86b5-4cc8fb0bc806"
|
|
breadcrumbs:
|
|
- "Brain"
|
|
- "Differential Diagnosis"
|
|
- "Arteries"
|
|
- "Anatomically Based Differentials"
|
|
- "Fusiform Arterial Enlargement"
|
|
---
|
|
# ESSENTIAL INFORMATION
|
|
|
|
- ## Key Differential Diagnosis Issues
|
|
|
|
|
|
- Ectasia = elongated/tortuous artery
|
|
- Fusiform aneurysm
|
|
- Long-segment fusiform arterial dilatation
|
|
- Can be acute (dissecting) or chronic (atherosclerosis, nonatherosclerotic vasculopathy)
|
|
- ## Helpful Clues for Common Diagnoses
|
|
|
|
|
|
- **Dolichoectasia**
|
|
- Dilated/elongated arteries ± slow flow
|
|
- Vessel layers intact
|
|
- Older patients, chronic hypertension
|
|
- Vertebrobasilar > internal carotid artery (ICA)
|
|
- Ectasia often extends into branches
|
|
- **Atherosclerotic Fusiform Aneurysm**
|
|
- Thick wall ± organized thrombus
|
|
- Variable slow flow
|
|
- **Dissecting Aneurysm/Pseudoaneurysm**
|
|
- Focal arterial dilatation
|
|
- Trauma = most common etiology
|
|
- Next to hard/fixed structures (bone, dura)
|
|
- **Nonaneurysmal Dissection**
|
|
- Vertebral > basilar > ICA
|
|
- Lacks changes of atherosclerosis in other vessels
|
|
- Can be spontaneous or traumatic
|
|
- ## Helpful Clues for Less Common Diagnoses
|
|
|
|
|
|
- **CNS Vasculitis**
|
|
- Involves multiple vessels
|
|
- Alternating stenoses and fusiform dilatations
|
|
- **Inherited Connective Tissue Disorders**
|
|
- Abnormal connective tissue involves vessel walls
|
|
- Aneurysm and dissections
|
|
- Thoracic aorta most common location
|
|
- **HIV Infection**
|
|
- Vasculopathy may be present in children or adults
|
|
- Multifocal fusiform enlargement involving supraclinoid ICA and basilar artery
|
|
- No consistent infectious agent isolated
|
|
- ## Helpful Clues for Rare Diagnoses
|
|
|
|
|
|
- **Giant Serpentine Aneurysm**
|
|
- Large, partially thrombosed mass
|
|
- Distal branches arise from aneurysm dome
|
|
- Lacks definable neck
|
|
- ICA/middle cerebral artery > vertebrobasilar artery
|
|
- **Atypical Saccular Aneurysm**
|
|
- Arises from vessel bifurcations
|
|
- Long "aspect ratio" → fusiform appearance
|
|
- Often multilobulated, bizarre
|
|
|
|
|
|
## Images
|
|
|
|
|
|
### Selected Images
|
|
|
|
|
|
*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='/img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
|
|
|
|
|
|
*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='/img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
|
|
|
|
|
|
*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='/img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
|
|
|
|
|
|
*Coronal CTA shows fusiform dilatation <img src='/img/arrows/CS.png'/> of the right supraclinoid internal carotid artery (ICA). Irregularity from atherosclerotic disease can be seen of the M1 segment of the middle cerebral artery <img src='/img/arrows/CO.png'/>. No significant mural thrombus was noted in this fusiform aneurysm.*
|
|
|
|
|
|
*Dissecting pseudoaneurysm in the V4 segment of the right vertebral artery seen on 3D TOF MRA <img src='/img/arrows/WS.png'/>, T2 <img src='/img/arrows/BS.png'/>, and T1 pre- <img src='/img/arrows/CS.png'/> and post <img src='/img/arrows/CO.png'/> DANTE VWI sequences shows peripheral enhancement, suggestive of instability.*
|
|
|
|
|
|
*3D MIP MRA of the vertebrobasilar arteries in a teenage female with a history of type 4 Ehlers-Danlos shows fusiform dilatation of the vertebral artery <img src='/img/arrows/CS.png'/>. The affected gene is COL3A1, and this specific type of Ehlers-Danlos has a higher risk of aneurysm and vascular rupture.*
|
|
|
|
|
|
*Axial MIP from CT arteriography shows fusiform dilatation of the left middle cerebral artery bifurcation <img src='/img/arrows/CS.png'/> in this child with a history of Marfan syndrome.*
|
|
|
|
|
|
*Coronal MIP reformat from CT arteriography shows bilateral fusiform aneurysms of supraclinoid ICAs <img src='/img/arrows/CS.png'/>. This patient also had thoracic aortic aneurysm, which is consistent with familial thoracic aortic aneurysm and dissection and is associated with a mutation of ACTA2. This gene is responsible for a component of vascular smooth muscle.*
|
|
|
|
|
|
*Axial T2WI MR shows strikingly enlarged middle cerebral arteries <img src='/img/arrows/CS.png'/> in this child with congenital HIV/AIDS (an uncommon but well-recognized cause of pediatric fusiform arteriopathy). The stroke-like presentations of HIV infection may relate to vasculopathies, including large-vessel aneurysmal vasculopathy.*
|
|
|
|
|
|
*Axial NECT demonstrates a giant serpentine aneurysm in the basilar artery <img src='/img/arrows/WC.png'/> with associated mural thrombus <img src='/img/arrows/CC.png'/> seen on sagittal CTA.*
|
|
|
|
|
|
### Additional Images
|
|
|
|
|
|
*Sagittal T1WI MR shows an elongated basilar artery with a slow-flow, thickened wall <img src='/img/arrows/WS.png'/>. The apex of the tortuous basilar artery indents the hypothalamus, 3rd ventricle <img src='/img/arrows/WO.png'/>.*
|
|
|
|
|
|
*Axial T2WI MR shows an elongated, tortuous basilar artery with a thickened arterial wall <img src='/img/arrows/BS.png'/>, typical for atherosclerosis-associated fusiform ectasia.*
|
|
|
|
|
|
*Lateral angiography shows a large fusiform middle cerebral artery aneurysm <img src='/img/arrows/BS.png'/> that extends into smaller, more distal branches <img src='/img/arrows/BO.png'/>. This is an unusual example because of the location (ICA, middle cerebral artery).*
|
|
|
|
|
|
*Axial T1WI MR shows an enlarged right vertebral artery with high signal intensity <img src='/img/arrows/WS.png'/> as well as an absent flow void of the left vertebral artery <img src='/img/arrows/WC.png'/>.*
|
|
|
|
|
|
*Anteroposterior oblique view of the left vertebral angiogram shows focal elongations and widening of the basilar artery <img src='/img/arrows/BS.png'/> in a 6-year-old child with Ehlers-Danlos type 4.*
|
|
|
|
|
|
*Axial MRA submentovertex view shows an unusual nonatherosclerotic giant serpentine fusiform aneurysm. The patent channel <img src='/img/arrows/WS.png'/> lies within the clot in the partially thrombosed <img src='/img/arrows/WO.png'/> lumen.*
|
|
|
|
|
|
*Lateral angiography in 30-year-old man with a subarachnoid hemorrhage shows an elongated, bizarre-appearing, multilobulated aneurysm <img src='/img/arrows/BS.png'/> with long aspect ratio, tit-like projections.*
|
|
|