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Acute Limited Intimal Tears of the Thoracic Aorta
Anne S Chin1, Martin J Willemink1, Aya Kino1
1Department of Radiology, Stanford University School of Medicine, Stanford, California.
Journal of the American College of Cardiology
|June 16, 2018
Summary
Limited intimal tears (LITs) are a rare variant of acute aortic syndrome (AAS). This study shows LITs can be detected with CT angiography, presenting similar outcomes to aortic dissection.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Thoracic Pathology
Background:
- Limited intimal tears (LITs) are an uncommon presentation of acute aortic syndrome (AAS).
- LITs are challenging to identify on medical imaging and may be overlooked.
- They represent a Class 3 dissection variant of aortic pathology.
Purpose of the Study:
- To determine the frequency, pathology, treatment, and outcomes of LITs.
- To compare LITs with other forms of AAS.
- To demonstrate the pre-operative detectability of LITs using advanced imaging techniques.
Main Methods:
- Retrospective review of 497 patients with 513 AAS events (2003-2012).
- Classification of AAS included classic dissection (AD), intramural hematoma, LIT, penetrating atherosclerotic ulcer, and rupturing thoracic aortic aneurysm.
- Analysis of prevalence, risk factors, imaging findings, surgical/pathological correlation, management, and outcomes.
Main Results:
- 24 LITs (4.8% of AAS) were identified; 17 were Type A and 7 Type B.
- Patients with LITs were older than those with AD; Type A LITs showed ascending aorta dilation similar to Type A AD.
- CT angiography detected all but one LIT, with volume-rendered images offering the best visualization.
Conclusions:
- Limited intimal tears are rare acute aortic lesions within the aortic dissection spectrum.
- LITs share similar presentations, complications, and outcomes with aortic dissection and intramural hematoma.
- Increased awareness and high-quality CT angiography enable pre-operative diagnosis of LITs.
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