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Everything you need to know about Computed Tomography (CT) & CT Scanning

Cardiac: Pseudoaneurysm Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Cardiac ❯ Pseudoaneurysm

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  • "Acute aortic injuries are not common in the setting of severe blunt trauma, but lead to significant morbidity and mortality. High- quality MDCT with 2D MPRs and 3D rendering are essential to identify aortic trauma and distinguish anatomic variants and other forms of aortic pathology from an acute injury. Misinterpretation of mimics of acute aortic injury can lead to unnecessary arteriography and thoracic surgery. Since most traumatic injuries occur in the distal arch, radiologists must be cognizant of the range of appearances of variants related to the ductus diverticulum. Cinematic rendering (CR) is a new 3D post-processing tool that provides even greater anatomic detail than traditional volume rendering."
    MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
    Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
    Emergency Radiology (2018) 25:209–213
  • "However, not all abnormalities of the aorta indicate an acute process, and multiple pitfalls that can mimic acute aortic injury have been described. Among these is the ductus diverticulum—a remnant of the ductus arteriosus that arises from the lesser curvature of the aortic arch, which can be mistaken for a traumatic aortic pseudoaneurysm, dissection, or incomplete rupture. The distal aortic arch, and in particular the undersurface, is the most common location for acute traumatic aortic injury.
    MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
    Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
    Emergency Radiology (2018) 25:209–213
  • “In most instances, surgery is indicated for asymptomatic patients without another underlying cardiovascular condition or disease, with aneurysms measuring greater than or equal to 5.5 cm. The risk of aortic dissection or rupture at diameters above 5.5 cm is generally perceived to exceed the risk of operation, warranting intervention. In patients with evidence of rapid aortic growth (>0.5–1 cm per year), elective surgical interven- tion should also be considered even if absolute size criteria have not been met.” 


    Pre- and Postoperative Imaging of the Aortic Root 
Hanneman K et al. 
RadioGraphics 2016; 36:19-37
  • “In the surgical context, the term pseudoaneurym is applied to any extravascular or extragraft blood-perfused space typically arising from a site of anastomosis, can- nulation, or arteriotomy, arising from an artery, graft, or the heart (for example, the infravalvular region of the left ventricular outflow tract).”

    Pre- and Postoperative Imaging of the Aortic Root 
Hanneman K et al. 
RadioGraphics 2016; 36:19-37
  • “A pseudoaneurysm is defined as a blood-filled space beyond the expected contours of an artery due to a partial or complete breach of the arterial wall, with a persistent communication to the bloodstream. Pathologically, a pseudoaneurysm may be contained by some, but not all, layers of the original arterial wall (for example, a traumatic aortic pseudoaneurysm may be contained by an intact adventitial layer), or it may be contained by surrounding tissues alone.” 


    Pre- and Postoperative Imaging of the Aortic Root 
Hanneman K et al. 
RadioGraphics 2016; 36:19-37
  • “Hyperattenuating felt pledgets may be mistaken for a pseudoaneurysm on contrast-enhanced CT angiograms, warranting careful evaluation of non- enhanced images to confirm the presence of the high-attenuation (polytetrafluoroethylene) surgical material. In comparison, pseudoaneurysms are usually iso- or hypoattenuating relative to surrounding tissue, and isoattenuating with the blood pool, on noncontrast CT images.” 


    Pre- and Postoperative Imaging of the Aortic Root 
Hanneman K et al. 
RadioGraphics 2016; 36:19-37
  • “Coronary artery anastomotic dehiscence is a rare complication following aortic root repair in Marfan's disease. In this patient who presented several years after surgery with mediastinal and chest wall hematoma, gated IV contrast enhanced cardiac CT was able to noninvasively localize left main coronary artery anastomotic dehiscence as the source of bleeding.”
    Dehiscence of coronary artery graft presenting as a right breast mass
    Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2
  • “Currently, there are two main types of surgical correction, the Bentall procedure or composite graft with aortic valve replacement, and aortic valve-sparing.  Both procedures have low operative risk.  Since a prosthetic valve is used in the Bentall procedure, it is associated with higher rates of thromboembolism, and thus these patients must be anti-coagulated. The valve-sparing procedure has lower rates of thromboembolism given the native aortic valve, but re-operation rates have been shown to be higher than the Bentall procedure.  Patients who undergo the Bentall procedure have lower late survival rates, but this is likely due to its preferred use in emergent higher risk cases.”
    Dehiscence of coronary artery graft presenting as a right breast mass
    Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2
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