Differential diagnosis of aortic aneurysms: pathomorphological criteria of various etiological forms

Aim: The aim of our study was to assess the concurrent validity of radiography and ultrasound examination among patients diagnosed with aortic aneurisms in Albania, a transitional country in South Eastern Europe. Methods: This study included 75 consecutive patients diagnosed with aortic aneurisms (thoracic and/or abdominal) admitted at the University Hospital Centre “Mother Teresa” in Tirana during 2012-2014 (56 men and 19 women). For each patient, computerized tomography (CT) scan with contrast was used to confirm the diagnosis of aortic aneurisms. In addition to the CT scan (“gold standard” for the diagnosis of aneurisms), in 37 patients, radiography and ultrasound examination were simultaneously performed in order to assess the validity of these techniques. Furthermore, demographic data and other relevant clinical information were collected for each study participant. Results: In 18 patients with thoracic aneurisms pertinent to ascendant aorta where radiography and ultrasound were simultaneously performed, ultrasound was able to diagnose 5 (27.8%) cases which were not detected through radiography (P=0.038). Conversely, in 16 patients with abdominal aneurisms where radiography and ultrasound were simultaneously performed, ultrasound was able to diagnose 4 (25.0%) cases which were not detected through radiography (P=0.034). The remaining three patients diagnosed with thoracic-abdominal aneurisms were not detected either by ultrasound examination or radiography. Conclusions: In this sample of Albanian patients diagnosed with aortic aneurisms (N=75), overall, 9 (24.3%) subjects were detected through ultrasound examination but not radiography (P<0.001). Findings from this study provide valuable clues about the concurrent validity and predictive value of these two key examinations for the diagnosis of aortic aneurisms.

Aortocoronary Saphenous Vein Graft Aneurysm: Diagnosis Using Color Doppler and Contrast Transesophageal Echocardiography

Problems in the diagnosis and treatment of abdominal aortic aneurysms

The Preoperative or premortem diagnosis of a mycotic abdominal aortic aneurysm due to Salmonella has been difficult. A febrile illness, with a positive blood culture for Salmonella, abdominal pain, and roentgen demonstration of displacement of the duodenum should suggest the possibility of such an aneurysm (1). We have recently encountered another radiographic finding extremely helpful in its preoperative diagnosis. Case Report A 70-year-old diabetic white male suffered epigastric pain, fever, and shaking chills one week prior to hospitalization. Physical examination on admission revealed a cachectic, confused patient. Blood pressure was 140/70 mm Hg; pulse, 88/minute, and temperature, 104°. The abdominal aorta was easily palpable and tender. Two blood cultures, as well as urine and stool cultures, were positive for Salmonella typhimurium. Plain abdominal x-ray films disclosed a localized gas accumulation surrounding a spherical mass about 6 em in diameter, The lesion seemed to encompass or be part of the abdominal aorta at the level of the third lumbar vertebra. The aorta was easily localized because of wall calcification (Fig. 1). Upper gastrointestinal studies showed, against the gastric antrum and the ascending duodenum, a pressure defect by the mass. With this information the preoperative diagnosis of a mycotic aneurysm of the abdominal aorta was made. At surgery an aneurysm was found arising just below the renal arteries and extending to the aortic bifurcation. As the retroperitoneal space was opened free pus was encountered, in which Salmonella typhimurium was subsequently cultured. The aneurysm was excised and replaced with a Dacron graft. The patient's course was difficult and he died on the twelfth postoperative day. Discussion and Summary In 12 of the 15 cases of mycotic (Salmonella) aortic aneurysm reported in the review of the literature by Sower and Whelan (2) the patient died from rupture of the aneurysm. The surgical result in a ruptured aortic aneurysm is very poor, but when a nonruptured aortic aneurysm is resected, the mortality rate is only 5 to 10 per cent. It is therefore imperative to make a correct diagnosis prior to rupture. In the case reported herein, a blood culture positive for Salmonella septicemia, combined with abdominal pain and a pulsatile, palpable, tender abdominal mass suggested the diagnosis of a mycotic aortic aneurysm. This was greatly strengthened by x-ray evidence of retroperitoneal gas surrounding the probable aneurysmal mass. Surgery was performed wi h a correct preoperative diagnosis.

A178 DIAGNOSIS OF A MYCOTIC AORTIC ANEURYSM USING ENDOSCOPIC ULTRASOUND: A CASE REPORT

Brucella aortitis should be one of the differential diagnoses of inflammatory aortic aneurysms. Insitu repair of intermittent aortoenteric fitulae and repair of infrarenal aortic aneurysm with synthetic graft can be used in clean scarred fistulae. Arterial aneurysms are very rare complications of Brucella infection. The purpose of this case report is to document a case of abdominal aortic aneurysm and primary aorto-duodenal fistula as a complication of Brucella infection, along with the management of brucella induced aortoenteric fistula with insitu synthetic graft. We report a 53-year-old man with a complaint of abdominal pain and melena. Radiological evaluation revealed an inflammatory abdominal aortic aneurysm and a primary aorto-duodenal fistula was identified during surgery. The patient underwent laparotomy, and surgical repair of the aneurysm with a bifurcated Dacron graft, while the entry of the aorto-duodenal fistula was closed with intra-aortic sutures. One month later, the patient tested positive for the Wright agglutination test (1:80) and Coomb's test (1:640) for brucella, and was treated with doxycycline, rifampicin, and ciprofloxacin for brucellosis. Though rare, brucella aortitis should be considered as one of the differential diagnoses of inflammatory aortic aneurysms. Insitu repair of intermittent aortoenteric fistula and repair of the infrarenal aortic aneurysm with synthetic graft could be considered in a clean scarred fistula.

Objective To discuss the value of echocardiography in the differential diagnosis of coronary artery fistula and aneurysm of valsalva sinus. Methods To analyze the feature of echocardiography in 3 patients with coronary artery fistula and 16 patients with rupture aneurysm of valsalva sinus. Results A preliminary diagnosis can be more clearly after the echocardiography worked for 19 patients. The results of the postop confirm that the diagnosis rate was 100%. Conclusions The echocardiography will have an important value in the differential diagnosis of coronary artery fistula and aneurysm of valsalva sinus. Key words: Coronary artery fistula; Aneurysm of valsalva sinus; Echocardiography; Differential diagnosis

Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography for Diagnosis of Infected Aortic Aneurysms

National Adherence to Medical Management of Aortic Aneurysms

Factors associated with dissection from inflammatory aortic aneurysms may be different from those in the general population. The aim of this study was to evaluate the risk factors for aortic dissection/rupture in patients with giant cell arteritis (GCA) and aortic aneurysms. A population-based incident cohort of patients with a diagnosis of GCA from 1950 to 2004 was used. All patients with aortic aneurysms diagnosed 1 year prior to GCA diagnosis or any time thereafter were included. Cox proportional hazard models were used to evaluate risk factors for aortic dissection/rupture. The study included 33 patients (91% women) with GCA and aortic aneurysms. Mean age at diagnosis of aortic aneurysm was 83.6 years. There were 27 thoracic aneurysms and 19 abdominal aneurysms. Eight patients developed aortic dissection/rupture (both thoracic and abdominal aorta in 5 cases, thoracic aorta only in 2 cases, and isolated abdominal aorta in 1 case).Older age (hazard ratio [HR], 0.27 per 10 years; 95% confidence interval [CI], 0.09-0.86) and later calendar year at diagnosis of aortic aneurysm (HR, 0.29 per 10 years; 95% CI, 0.13-0.69) were associated with decreased risk of dissection/rupture. Size of the thoracic aneurysm (HR, 1.17; 95% CI, 0.69-1.99) was not associated with dissection/rupture. Histopathology showed active aortitis in 4 of 7 patients with aortic dissection/rupture compared with 0 of 7 patients with aortic aneurysm without dissection/rupture. Aneurysm size was not a predictor of aortic dissection/rupture in this cohort of patients with GCA. The higher frequency of active aortitis in patients with dissection suggests that active inflammation may play a role.

This study aims to review the application of deep learning techniques in the imaging diagnosis and treatment of aortic aneurysm (AA), focusing on screening, diagnosis, lesion segmentation, surgical assistance, and prognosis prediction. A comprehensive literature review was conducted, analyzing studies that utilized deep learning models such as Convolutional Neural Networks (CNNs) in various aspects of AA management. The review covered applications in screening, segmentation, surgical planning, and prognosis prediction, with a focus on how these models improve diagnosis and treatment outcomes. Deep learning models demonstrated significant advancements in AA management. For screening and diagnosis, models like ResNet achieved high accuracy in identifying AA in non-contrast CT scans. In segmentation, techniques like U-Net provided precise measurements of aneurysm size and volume, crucial for surgical planning. Deep learning also assisted in surgical procedures by accurately predicting stent placement and postoperative complications. Furthermore, models were able to predict AA progression and patient prognosis with high accuracy. Deep learning technologies show remarkable potential in enhancing the diagnosis, treatment, and management of AA. These advancements could lead to more accurate and personalized patient care, improving outcomes in AA management.

Pseudocoarctation of the aorta: An important consideration in the differential diagnosis of superior mediastinal mass

Aortic aneurysm with valvular insufficiency: Is it due to Marfan syndrome or hypertension? A case report and review of literature

The ascending aorta and aortic arch aneurysm surgical correction is the most difficult problem of cardiovascular surgery due to the necessity of management of the main disease and adequate protection of the brain and visceral organs. The aim. To present the methods and results of protection of the central nervous system and visceral organs during the correction of the ascending aorta and aortic arch aneurysm or isolated aortic arch aneurism. Materials and methods. During 1994–2018, we operated 419 patients with the ascending aorta and aortic arch aneurysm (or isolated aortic arch aneurism). Diagnosis of aneurysms was based on clinical data, transthoracic and transesophageal echocardiography, computed tomography, X-ray examination, aortography. All operations were performed under general anesthesia, through the median sternotomy using cardiopulmonary bypass. Valve-sparing technique with aortic valve resuspension/aortic valve plasty and semi-arch/arch replacement was used in 288/9 (68.7%) patients. Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%) patients. Other operations accounted for 45 (10.7%) patients. Results. The history of the development of aortic aneurysms treatment options is briefly overviewed in the paper. Diagnostic methods are mentioned, but the main method today is computed tomography. Initial status of the patients was severe. All operations were performed through median sternotomy using cardiopulmonary bypass. The following techniques were used for surgical treatment of aneurysms: 1) valve-sparing technique with aortic valve resuspension/ plasty and semi-arc/arch replacement was used in 288/9 (68.7%) patients. In this group there were 8 Yacoub operations, 6 David operations. In 7 patients, plication of one of the leaflets was performed in case of aortic valve prolapse. 3 patients underwent strengthening of the free edge of the leaflets and 4 patients underwent plasty by the patch in case of leaflet fenestrations; 2) Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%); 3) others: isolated arch in 15 (3.6%); Wheat operation + arch in 9 (1.0%); aortic arch plasty in 4 (1.0%); Elephant trunk (conventional Elephant trunk) + TEVAR was used in 17 (4.1%) patients. The brain protection was performed differently at each of the two stages in our surgical experience. The best result was achieved at the last stage. The number of postoperative complications decreased from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%, respectively. Also, a modern endovascular method – hybrid operations Elephant trunk + TEVAR – was used in 17 (4.1%) patients with good immediate result. Conclusions. 1. At type A aortic dissection (DeBakey type I) the operation of choice is supracoronary ascending aortic replacement with a semi-arch (arch) replacement of the aorta. 2. Accumulation of surgical experience, team training, improvement of methods of protection of the brain and visceral organs allowed to reduce the number of postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%.

Objective: To explore and analyze the diagnostic value of electrocardiogram(ECG) in aortic dissection aneurysm. Method: From February 2018 to September 2019, 80 patients with suspected aortic dissection aneurysm received in our hospital were selected, 30 patients were examined by ECG, 30 patients were examined by CT, and 20 patients were examined by echocardiography. The diagnostic standard is digital subtraction angiography, and the value of ECG in the diagnosis of aortic dissecting aneurysms is analyzed. Result: Compared with ECG, the diagnosis of aortic dissecting aneurysm by CT and echocardiography has more obvious advantages in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Conclusion: The application of ECG in the diagnosis of aortic dissecting aneurysm has a lower clinical value than CT and echocardiography, but the ECG has the characteristics of non-invasive and fast, and can be used in the emergency of aortic dissecting aneurysm.