image diagnosis: thoracic aortic dissection and thoracic aortic

88 The Permanente Journal/ Spring 2011/ Volume 15 No. 2 CLINICAL MEDICINE Image Diagnosis: Thoracic Aortic Dissection and Thoracic Aortic Aneurysm Sundeep R Bhat, MD Gus M Garmel, MD, FACEP, FAAEM Sundeep R Bhat, MD, is an Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in CA. E-mail: [email protected]. Gus M Garmel, MD, FACEP, FAAEM, is a Senior Emergency Medicine Physician at the Kaiser Santa Clara Medical Center, Co-Program Director of the Stanford/Kaiser Emergency Medicine Residency Program, and Clinical Professor (Affiliated) of Surgery (Emergency Medicine) at Stanford University School of Medicine in CA. He is also a Senior Editor for The Permanente Journal. E-mail: [email protected]. Figure 1. Thoracic Aortic Dissection Although plain film chest radiograph may be used to screen for a widened mediastinum (ImageA) which suggests thoracic aortic dissection, computed tomography (CT) angiography or traditional angiography are gold-standard tests and should be obtained in any stable patient for whom dissection is suspected. 1,2 Thoracic aortic dissection is generally classified using the Stanford scheme, although some texts and cardiothoracic surgeons still use the DeBakey classification (types I - III). Image B demonstrates dissection flaps seen in both the ascending and descending aorta (StanfordType A—any involvement of the ascending aorta irrespective of site of intimal tear or distal extension). 2 Complications ofType A dissections include aortic valve insufficiency, dissection into coronary vessels causing acute myocardial infarction, and dissection into the pericardial sac (Image C) causing hemopericardium and possible tamponade physiology. 1 Type A dissection requires immediate surgical intervention. Image D shows an intimal flap in the descending aorta only (StanfordType B). Patients with uncomplicatedType B dissections are typically managed medically, with blood pressure control by pharmacologic intervention. 1,2 A C B D

Upload: others

Post on 12-Sep-2021

16 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Page 1: Image Diagnosis: Thoracic Aortic Dissection and Thoracic Aortic

88 The Permanente Journal/ Spring 2011/ Volume 15 No. 2

CLINICAL MEDICINE

ImageDiagnosis:ThoracicAorticDissectionandThoracicAorticAneurysmSundeep R Bhat, MD Gus M Garmel, MD, FACEP, FAAEM

Sundeep R Bhat, MD, is an Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in CA. E-mail: [email protected] M Garmel, MD, FACEP, FAAEM, is a Senior Emergency Medicine Physician at the Kaiser Santa Clara Medical Center, Co-Program Director of the Stanford/Kaiser Emergency Medicine Residency Program, and Clinical Professor (Affiliated) of Surgery (Emergency Medicine) at Stanford University School of Medicine in CA. He is also a Senior Editor for The Permanente Journal. E-mail: [email protected].

Figure1.ThoracicAorticDissectionAlthoughplainfilmchestradiographmaybeusedtoscreenforawidenedmediastinum(ImageA)whichsuggeststhoracicaortic

dissection,computedtomography(CT)angiographyortraditionalangiographyaregold-standardtestsandshouldbeobtainedinanystablepatientforwhomdissectionissuspected.1,2ThoracicaorticdissectionisgenerallyclassifiedusingtheStanfordscheme,althoughsometextsandcardiothoracicsurgeonsstillusetheDeBakeyclassification(typesI-III).ImageBdemonstratesdissectionflapsseeninboththeascendinganddescendingaorta(StanfordTypeA—anyinvolvementoftheascendingaortairrespectiveofsiteofintimaltearordistalextension).2ComplicationsofTypeAdissectionsincludeaorticvalveinsufficiency,dissectionintocoronaryvesselscausingacutemyocardialinfarction,anddissectionintothepericardialsac(ImageC)causinghemopericardiumandpossibletamponadephysiology.1TypeAdissectionrequiresimmediatesurgicalintervention.ImageDshowsanintimalflapinthedescendingaortaonly(StanfordTypeB).PatientswithuncomplicatedTypeBdissectionsaretypicallymanagedmedically,withbloodpressurecontrolbypharmacologicintervention.1,2

Page 2: Image Diagnosis: Thoracic Aortic Dissection and Thoracic Aortic

89The Permanente Journal/ Spring 2011/ Volume 15 No. 2

CLINICAL MEDICINEImageDiagnosis:ThoracicAorticDissectionandThoracicAorticAneurysm

Figure 2.ThoracicAorticAneurysmwithRupture

Aneurysmal dilatation of the de-scendingthoracicaortacanbeseeninpatients with atherosclerotic disease,as well as in patients with collagenvascular disorders like Marfan’s syn-drome.1Theseimages(ImageAandB)demonstratethoracicaorticaneurysmrupture with extravasation of bloodinto the adjacent pleural space. Riskofruptureincreaseswithsize;growthmaybe0.1-0.4centimeters(cm)peryear;riskofrupturebecomeshighafterreaching6cmindiameter.Forstablepatientswithoutsymptoms,computedtomography or magnetic resonanceimagingat regular intervals is recom-mended,asisbeta-blockertherapyforbloodpressurecontrol.1v

References 1. Creager MA, Loscalzo J. Diseases of

the Aorta. In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine (17th edition). New York, NY: McGraw-Hill Compa-nies Inc; 2008. p 1563-7.

2. Manthey DE . Aortic Dissection and Aneurysms. In: Ma OJ, Cline DM, Tintinalli JE, et al. Emergency Medicine Just the Facts (2nd edition). New York, NY: McGraw-Hill Companies Inc; 2004. p 118-20.

Aortic dissection 2015

Rapid Diagnosis and Management of Thoracic Aortic ...€¦ · dissection[3–5]; however, the diagnostic accuracy of bi-plane versus multiplane TEE for aortic dissection and intramural

in thoracic aortic aneurysm and dissection€¦ · Thoracic aortic aneurysm and dissection (TAAD) causes significant morbidity and mortality, yet the molecular changes occurring in

BCC4: Plunkett on Thoracic Aortic Dissection

Pulmonary Embolism Aortic Aneurysm Aortic Dissection

Case Report Familial Thoracic Aortic Aneurysm with ...downloads.hindawi.com/journals/crim/2014/842872.pdf · Familial Thoracic Aortic Aneurysm with Dissection Presenting ... TAAD

CHAPTER VII - Acute Aortic Dissection · 2014. 5. 27. · CHAPTER VII - Acute Aortic Dissection 7.1. Background.Acute aortic dissection is a major medical and surgical emergency,

Society for Vascular Surgery (SVS) and Society of Thoracic ... · aortic dissection (arrow) involving the aortic arch. (B) Coronal CTA image of this same aortic dissection clearly

Diagnosis of Aortic Dissection

Acute Aortic Dissection Acute Aortic Dissection by Abde alaziz gomaa MSc. Cardiology

Blunt Thoracic and Abdominal Aortic Injurychuliege-imaa.be/pdf/presentations_2014/Vendredi-12/8h30 starnes.… · Blunt Thoracic and Abdominal Aortic Injury ... Blunt Thoracic Aortic

Vascular Deformation Mapping (VDM) of Thoracic Aortic ... · PDF fileVascular Deformation Mapping (VDM) of Thoracic Aortic Enlargement in Aneurysmal Disease and Dissection Nicholas