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CT of calcified chronic aortic dissection simulating atherosclerotic aneurysm
J Hachiya1, T Nitatori, A Yoshino
1Department of Radiology, University of Kyorin School of Medicine, Tokyo, Japan.
Insights
Peripheral aortic calcification can mimic aneurysms but may indicate chronic aortic dissection. This finding, seen in 8% of cases, highlights the need for advanced imaging to differentiate dissection from atherosclerosis.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Vascular Pathology
Background:
- Peripheral calcification of the aorta typically suggests atherosclerotic aneurysm.
- Occasionally, this calcification pattern is observed in chronic aortic dissection, potentially leading to misdiagnosis.
Purpose of the Study:
- To investigate the occurrence and diagnostic implications of peripheral aortic calcification in chronic aortic dissection.
- To differentiate this calcification from atherosclerotic changes using imaging modalities.
Main Methods:
- Retrospective review of conventional chest roentgenography and CT scans from 50 patients with angiography-proven chronic aortic dissection.
- Analysis of calcification patterns in relation to true and false lumens.
Main Results:
- Eight percent (4/50) of chronic aortic dissection cases exhibited calcification in the outermost wall of the affected aorta.
- In Stanford type A dissections, calcification mimicked ascending aortic aneurysm; in type B, it appeared as a calcified hump in the descending aorta.
- Computed tomography confirmed peripheral calcification was located in the outermost wall of the false lumen, with two cases showing calcification exclusively in the false lumen.
Conclusions:
- Peripheral aortic calcification can be an indicator of chronic aortic dissection, not solely atherosclerotic aneurysm.
- Endothelialization of the false lumen may facilitate rapid atheromatous changes, leading to calcification.
- Advanced imaging is crucial for accurate diagnosis when peripheral aortic calcification is present in dissection cases.
Abstract:
Calcification along the outermost aspect of the aorta usually means atherosclerotic aneurysm. On occasion, however, this peripheral type calcification is seen in chronic aortic dissection and leads to a misdiagnosis. Conventional chest roentgenography and CT of 50 cases of chronic dissection proven by angiography were reviewed. Four of these cases (8%) showed calcification in the outermost wall of the affected portion of the aorta. Two cases were Stanford type A and the other two cases were type B. In type A cases chest roentgenography showed calcification in the wall of the dilated ascending aorta closely mimicking aneurysm. In type B cases, calcification was in the outer wall of a localized hump in the descending aorta. Computed tomography clearly demonstrated that this peripheral calcification was located in the outermost wall of the false lumen. Review of the pathologic literature shows sporadic reports of such phenomenon and a theory of endothelialization of the false lumen. It is presumed that the endothelialized false lumen may develop atheromatous changes much more rapidly than the true lumen since two of four cases showed calcification only in the wall of the false lumen with the intimal flap and the wall of the true lumen remaining noncalcified.