Intramural aortic dissection

Wambeek, Nicholas; Cameron, DC; Holden, Andrew

doi:10.1111/j.1440-1673.1996.tb00444.x

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…They account for approximately 13% of all cases of acute aortic dissection 1 and yet little is known about the incidence, complications, morbidity and mortality associated with surgical versus medical therapy. There is some evidence that the mortality may be as high as in classic dissection 2 . The key radiological finding is the presence of a hyperdense rim in the aortic wall on a non‐contrast CT scan 3 .…”

Section: Discussionmentioning

confidence: 99%

Intramural haematoma of the thoracic aorta: Rupture and endoluminal exclusion

Buckenham

2007

Australasian Radiology

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Intramural haematoma is an increasingly recognized condition, characterized by an acute haemorrhage into the aortic wall without the creation of a pseudolumen. We present a case that was diagnosed by non-contrast CT scanning, which showed a hitherto undescribed contained rupture into the mediastinum, but no haemothorax. This complicated intramural haematoma was then successfully treated with endoluminal exclusion, which was performed during frank rupture of the thoracic aorta into the left hemithorax which occurred just before the commencement of the endoluminal exclusion.

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Section: Discussionmentioning

confidence: 99%

Intramural haematoma of the thoracic aorta: Rupture and endoluminal exclusion

Buckenham

2007

Australasian Radiology

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“…The entity of acute aortic intramural haematoma has been more widely recognized in recent years. 1,2 Clinically, the condition often mimics classical aortic dissection. Theories regarding aetiology include: (i) classical aortic dissection with a thrombosed false lumen; (ii) spontaneous intramural haematoma; and (iii) penetrating atherosclerotic ulcer.…”

Section: Discussionmentioning

confidence: 99%

“…Theories regarding aetiology include: (i) classical aortic dissection with a thrombosed false lumen; (ii) spontaneous intramural haematoma; and (iii) penetrating atherosclerotic ulcer. 2 …”

Section: Discussionmentioning

confidence: 99%

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The value of narrow CT window settings in the recognition of subtle acute aortic intramural haematoma

Holden

2000

Australasian Radiology

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Four patients with acute aortic intramural haematoma are presented. In all patients the typical crescentic hyperdense rim within the aortic wall was not obvious on unenhanced CT when reviewed on standard mediastinal windows, but the hyperdense crescentic rim was well seen on narrow window settings. The findings suggest that all patients with a typical clinical presentation of acute thoracic aortic dissection who do not have a classical dissection on contrast-enhanced CT or a hyperdense intramural haematoma on standard mediastinal settings, should have the non-contrast scans reviewed on narrow window settings.

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“…In-hospital rupture rates of 25% have been reported, with serial surveillance imaging estimating continuing aortic expansion rates of 0.4 cm per annum. Angiography is unlikely to yield a positive diagnosis in cases of intramural haematoma, with CT and MRA, providing the gold standard in imaging [9][10][11].…”

Section: Intramural Haematomasmentioning

confidence: 98%

Dissections of the Thoracic Aorta and Evolving Endovascular Strategies

Ali¹,

Sayers²,

Biasi³

et al. 2009

CHYR

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Acute dissection is the most common life threatening condition of the aorta affecting 5-30 per million people per year [1].Left untreated, the majority of patients with dissections involving the ascending aorta will die within days of an acute episode [2].Patients presenting with descending thoracic aortic dissections seem to fare better, with one in ten patients dying before leaving hospital. Ultimately, these patients are at risk of aortic rupture with nearly 20% of these patients requiring some form of surgical or endovascular intervention [3].Judicious medical, surgical and endovascular management of this condition aims to reduce propagation of the dissection plane and concomitant branch vessel compromise, halt aortic expansion and prevent fatal aortic rupture.Early recognition of these disease entities in conjunction with urgent and pertinent management is the key to a successful outcome in these patients. DEFINITIONAcute dissection results from sudden tear of the intima and separation of the layers within the aortic wall. This results in the longitudinal and spiralling flow of pulsatile blood between the inner and outer layers of the tunica media propagating the extent of dissection with the variable formation of both true and false lumina Fig. (1).Dynamic obstruction of the true lumen by the expanding false lumen will result in organ ischaemia unless spontaneous and adequate fenestration of the distal intimal flap does not occur [4]. Often these fenestrations can be found at the site of branched vessel ostia leaving the native aorta to supply target organs. Disruption of the intima here, often leads to invagination of the intima within the target vessel with static obstruction of laminar blood flow in the true lumen and the high probability of arterial thrombosis and end organ infarction. ACUTE AORTIC SYNDROMEIn addition to aortic dissections, two further aortic pathologies often encountered are penetrating aortic ulcers and intramural haematomas. Both these conditions are found in a more elderly hypertensive population in whom women predominate. Grouped together, the three pathologies have been coined the acute aortic syndrome and are representative of Fig. (1). Arch aortogram demonstrating true lumen collapse (T) and extraluminal expansion of false lumen (F) in a Stanford type B aortic dissection. The main communication between the true and the false lumens occurs immediately beyond the left subclavian artery (C).degenerative changes encountered in the atherosclerotic aortic wall. In comparison to acute aortic dissection, visceral and limb ischaemia do not appear to be a prevalent feature of either penetrating ulcers or intramural haematomas.

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Intramural aortic dissection

Cited by 7 publications

References 14 publications

Intramural haematoma of the thoracic aorta: Rupture and endoluminal exclusion

Intramural haematoma of the thoracic aorta: Rupture and endoluminal exclusion

The value of narrow CT window settings in the recognition of subtle acute aortic intramural haematoma

Dissections of the Thoracic Aorta and Evolving Endovascular Strategies

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