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Non-traumatic thoracic aortic emergencies: imaging diagnosis and management

Jian Ping Jen1, Akif Malik1, Gareth Lewis1

  • 1Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

British Journal of Hospital Medicine (London, England : 2005)
|November 2, 2020
PubMed

Insights

Acute aortic syndromes, including dissection and intramural hematoma, are life-threatening emergencies. Early diagnosis via CT angiography is crucial for timely management, guiding treatment decisions for Type A and Type B aortic pathologies.

Area of Science:

  • Cardiovascular Medicine
  • Radiology
  • Emergency Medicine

Background:

  • Non-traumatic thoracic aortic emergencies, primarily acute aortic syndromes (AAS), are clinically indistinguishable and highly fatal.
  • AAS encompass acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer, all involving aortic wall disruption.
  • These conditions pose significant risks, including rupture, end-organ ischemia, and aneurysm formation, necessitating prompt diagnosis and management.

Purpose of the Study:

  • To review the diagnostic computed tomography (CT) features of acute aortic syndromes.
  • To highlight morphological features associated with complications in AAS.
  • To outline current management strategies for different types of AAS.

Main Methods:

  • Review of diagnostic imaging characteristics of AAS using paired unenhanced and electrocardiogram-gated computed tomography angiography (CTA) of the chest.
  • Analysis of specific CT findings related to acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer.
  • Correlation of imaging findings with clinical outcomes and management pathways.

Main Results:

  • CTA is the recommended diagnostic modality for AAS, providing detailed morphological information.
  • Specific CT features can predict complications such as rupture, ischemia, and aneurysm.
  • Management strategies vary based on AAS type and complication status: Type A typically requires surgery, uncomplicated Type B receives medical therapy, and complicated Type B may involve surgery or endovascular repair.

Conclusions:

  • Accurate and timely diagnosis of AAS through CTA is critical for effective patient management.
  • Understanding CT features aids in identifying high-risk patients and guiding treatment decisions.
  • Current management algorithms differentiate treatment based on aortic pathology type and the presence of complications.

Keywords:
Acute diseaseAortic diseasesAortic ruptureDiagnostic imagingDissecting aneurysm

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