Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.
Highlights
Acute non-traumatic thoracic aorta emergencies (TAE) often present with similar clinical symptoms, and thereby investigation of the appropriate management algorithm is heavily reliant on radiological findings [1,2]
Five segments of the thoracic aorta can be differentiated: the intrapericardial root; the ascending aorta; the extrapericardial aortic arch extending from the brachiocephalic trunk (BCT) to the left subclavian artery (LSA); the isthmus; and the descending thoracic aorta (DTA)
positron emission tomography (PET)/CT has high sensitivity for medium- to large-vessel vasculitis and can be very useful in demonstrating aortic graft infection [129]. Both aortitis and periaortitis may arise in the context of IgG4-related disease that is defined as idiopathic inflammatory and sclerosing lesions infiltrated by numerous IgG4-positive plasma cells with multi-organ effects, including the vascular system [130,131]
Summary
Acute non-traumatic thoracic aorta emergencies (TAE) often present with similar clinical symptoms, and thereby investigation of the appropriate management algorithm is heavily reliant on radiological findings [1,2]. State-of-the-art multidetector-computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive, multiplanar imaging with excellent diagnostic performance (sensitivity/specificity 98–100%), offering a detailed visualization of the entire aorta, aortic branches including aberrant anatomy, and its surrounding structures (Figure 1) [7,8]. It is the gold standard for aortic imaging and plays a pivotal role in the patient’s management and care [9]. The aim of this review was to provide an overview of imaging of acute non-traumatic aortic pathology, emphasizing the role of the state-of-the-art CTA imaging, the clues to diagnosis, and the impact on variable management strategies
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