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Aorta (Aortic dissection (Differentiate true and false lumen (Thrombus (T:…
Aorta
Aortic dissection
Classification
Stanford classification
Type B
Descending aorta
Type A
Descending aorta
Ascending aorta
De Bakey Classification
Type 1
Dissection of entire aorta
Type 2
Dissection of ascending aorta
Type 3
Dissection of descending aorta
New classification
Class 1
Classical aortic dissection with intimal flap between true and false lumen
Class 2
Medial disruption with formation of intramural hematoma/hemorrhage
Class 3
Discrete/suble dissection without hematoma
Eccentric bulge at tear site
Class 4
Plaque rupture
Aortic ulceration
Class 5
Iatrogenic and traumatic dissection
Differentiate true and false lumen
Size
Size: True < False
Pulsation
True expand in systolic, false vice versa
Flow direction
True lumen - systolic antegrade flow; False: Retrograde flow/reduced antegrade flow
Localization of within aortic arch
T: Inner countour; F: Outer contour
Signs of slow flow
T: Rare; F: frequent, depending on the degree of communication
Thrombus
T: Rare
F: Frequent, depending on degree of communication
Type of dissection
Communicating-Non communicatiing
Communicating
Intimal tear
Flow within false lumen
Phasic motion of intimal flap
High flow signals in false lumen
No or incomplete thrombus formation in false lumen
Non Communicating
Intima intact
No flow in false lumen
No or reduced motion of intimal flap
Signs of reduced flow. SEC +
Thrombus formation in the false lumen - incomplete or complete
Differentiate with aneurysm
Diameter
Aneurysm:
Aortic diameter increase significantly
Dissect
Increase
Wall thickness
Aneurysm
Increase
Dissect
Normal except for intramural hematoma; intramural hemorrhage
Luminal surface
Aneurysm
Rough
Dissection
Smooth
Thrombus formation
Aneurysm
Lumen
Dissection
False lumen
Floating thrombi
Aneurysm
++
Dissec
False lumen
Displacement of intimal calcifications
Aneurysm
+
Dissec
++
Classic dissection
Characterized by
True and false lumen
Intimal tear/Entry site: communication between Lumen
Intimal flap
Diagnosed by:
Short axis
Intimal flap, consist of
Intima
Media (inner 2/3)
Long axis
Entry site
Re entry
Intimal flap, consist of
Intima
Media (inner 2/3)
Marker of classic dissection
Axial view
Beak Sign
Cob Web Sign
Wrap sign in the aortic arch
Aortic aneurysm
Location
TAA
AAA
TAAA
Type
Fusiform
Saccular
Form
Lobulated contour
Rapid expansion or development and adjacent mass
Stranding
Fluid in unusual location
HIGHLY SUSPICIOUS
Infected aneurysm
TB
Mycotic
Vasculitis
Diameter
Neck
Iliac Arteries Tortuosity
MSCT
MSCT Indication
Condition related
Surveillance after surgical repair or TEVAR/EVAR
Follow up of medically treated type B dissect
Diagnosis of acute dissection
Disease related
Aortic aneurysm
Area
Thoracic
Abdominal
Emergency/acute
Exclude rupture
Exclude leaks
Exclude dissection
Exclude intramural hematoma
Exclude traumatic injury
Elective
Consideration for EVAR
Follow up after EVAR
Follow up after surgery
Non-aneurysmal disease
Aortic stenosis
Aortic occlusion
Peripheral vascular system
Critical ischemia
Claudication
Visceral angiography
Renal
Evaluation of potential living renal donors
Evaluation of renal artery stenosis
Vascular mapping with PUJO and tumors
Mesenteric ischaemia
Hepatic angiography
Coronary Circulation
Cerebral circulation
Pulmonary circulastion
MSCT Limitation
AR cannot be diagnosed with CT
Failure to opacify false lumen
PLUS SIDE
Superior than catheter angio
Demonstrate mural thrombus
perianeurysmal blood
Co-existent non vascular abdominal disease
Standard Anatomic Landmark