Colour Doppler and grey scale ultrasound features of HIV-related vascular aneurysms

Abstract

Atypical aneurysms of large elastic arteries owing to human immunodeficiency virus (HIV) vasculopathy are a well described complication of acquired immunodeficiency syndrome (AIDS). However, there are no reports describing the ultrasound features of these lesions. We performed a retrospective review of ultrasound images of 12 patients presenting with 39 HIV-related aneurysms over a 2 year period. Of these there were a total of 12 patients with symptomatic lesions comprising the superficial femoral artery (n=5), the origin of the internal carotid artery (n=3), the popliteal artery (n=2), the common femoral artery (n=1) and the common iliac artery (n=1). The remainder were asymptomatic and were demonstrated radiologically. The ultrasound features of large symptomatic HIV-related femoral and carotid aneurysms were typical of pseudoaneurysms with a defect or "blow-out" in the vessel wall and turbulent pulsatile flow. Of note was the presence of marked thickening of the vessel adjacent to the aneurysm and hyperechoic "spotting" of the arterial wall. These ultrasound features described may be unique to HIV vasculopathy.

HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice: review article

“…As a general principle, aneurysms found clinically at one location guided the screening for aneurysms at other locations. Duplex ultrasound features characterised by forward and backward flow within a pseudo-aneurysm are reflected as a ‘yin-yang’ sign 32 (Fig. 2D) , cavitational echogenicity and turbulent flow with a vessel wall defect (Fig.…”

“…2E) . 32 This pathological process is eclipsed by adjacent hypo-echoic spotting and vessel wall thickening with normal proximal and distal vasculature. Patients deemed suitable for surgery are subjected to definitive imaging in the form of angiography or computerised tomographic angiography.…”

Yin-yang sign on magnetic resonance imaging in a child with left frontal arterio-venous malformation and foot drop

“…4). Yin-yang sign was originally used to describe the swirling pattern seen on color-flow Doppler sonography secondary to intermittent blood flow into and out of a pseudoaneurysm lumen [9]. Subsequently, it was described in contrast CT of a partially thrombosed aneurysm with the areas of hyper-attenuation indicating partially contrast-filled lumen and the areas of hypo-attenuation indicating the presence of mural thrombus [1,10].…”

HIV-Associated Vasculopathy

“…This suggested that endothelial cell dysfunction may play a role, as a predisposing factor for primary thrombosis. Hypercoagulable states associated with the HIV infection, including antiphospholipid antibody syndrome, deiciencies in free protein S, protein C, and antithrombin III, could predispose patients to arterial thrombosis [18,19].…”