Abstract
Acute aortic syndromes (AAS) encompass a spectrum of life-threatening conditions characterized by acute aortic pain. AAS include acute aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aneurysm rupture. The prognosis of AAS is clearly related to prompt diagnosis and appropriate management. The different types of AAS cannot be reliably differentiated solely based on clinical presentation since the clinical features are indistinguishable. Multidetector-row computed tomography (MDCT) with electrocardiographic gating (ECG-gated MDCT) has been used in the acute emergency setting as a powerful clinical tool, which enables rapid and specific diagnosis of aortic pathologies. ECG-gated MDCT significantly reduces motion artifact and avoids potential pitfalls in the diagnosis of AAS. The aim of this review is to evaluate the role of MDCT imaging in the assessment of AAS and to discuss the differentiation of this spectrum of aortic diseases with reference to the key imaging findings.
Highlights
BackgroundAcute aortic syndromes describe the acute presentation of patients with characteristic aortic pain caused by one of several life-threatening conditions of aortic diseases
The aim of this review is to evaluate the role of Multidetector-row computed tomography (MDCT) imaging in the assessment of Acute aortic syndromes (AAS) and to discuss the differentiation of this spectrum of aortic diseases with reference to the key imaging findings
In a study published in JAMA, a widened mediastinum was noted in 61.1% of aortic dissection cases, displacement of calcification of the aorta was reported in 14.1% of cases, with an abnormal cardiac contour being noted in 25.8% [32]
Summary
Acute aortic syndromes describe the acute presentation of patients with characteristic aortic pain caused by one of several life-threatening conditions of aortic diseases. A. Axial contrast-enhanced CT image demonstrating an intimal flap (arrows) consistent with a Stanford Type A dissection with extension into the distal thoracic aorta. Contrast-enhanced magnetic resonance angiography is more available for the investigation of aortic dissection in medically stable patients or those with chronic dissections It has several advantages over MDCT angiography, including a lack of non-ionizing radiation, multiplanar evaluation, and greater vessel coverage at high resolution. Triple rule-out MDCT protocol is used to assess the aorta, coronary arteries, and pulmonary arteries during a single scan with the use of several optimally timed boluses of contrast material and ECG gating in patients who are at low risk for an acute coronary syndrome. Axial image (A) and coronal reformat (B) of the contrast-enhanced CT demonstrate an atheromatous plaque in the abdominal aorta extending beyond the intima into the aortic media. MDCT angiography may be helpful to depict signs of impending hypovolemic shock via presenting reduction in the caliber of central vessels and excessive contrast enhancement of the aorta relative to the injection parameters [9,11,47,48]
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