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Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta
Published on: September 8, 2023
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Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and Diagnostic Pitfalls
Aishwarya Gulati1, Harit Kapoor1, Achala Donuru1
1From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.).
Summary
Spontaneous aortic fistulas (AoFs) are rare, life-threatening conditions often linked to weakened blood vessels. Prompt diagnosis via CT angiography is crucial for effective management and improved patient outcomes.
Area of Science:
- Vascular Surgery
- Radiology
- Gastroenterology
Background:
- Aortic fistulas (AoFs) are uncommon but critical vascular emergencies.
- They often arise from trauma, interventions, or weakened vasculature due to atherosclerosis, connective tissue diseases, vasculitis, or infection.
Purpose of the Study:
- To highlight the diagnostic challenges and imaging findings of spontaneous aortic fistulas.
- To emphasize the importance of prompt diagnosis and management strategies for these rare conditions.
Main Methods:
- Review of clinical presentations and imaging findings of aortic fistulas.
- Focus on multiphasic multidetector CT angiography as the primary diagnostic tool.
Main Results:
- Clinical features are often nonspecific, including bleeding, pain, fever, and shock.
- CT angiography reveals direct signs like contrast extravasation and indirect signs such as fat plane loss and ectopic gas.
- Indirect signs can mimic infection or postoperative changes, necessitating careful interpretation.
Conclusions:
- Radiologists must maintain a high index of suspicion for AoFs in at-risk patients presenting with bleeding.
- Management is complex, often requiring staged surgical procedures tailored to the patient's condition and fistula characteristics.
- Increasing endovascular interventions underscore the need for vigilance in diagnosing AoFs.
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