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Questions and Answers
What is the main cause of an aneurysm?
What is the normal diameter of the ascending aorta?
What type of aneurysm occurs when there is a tear through all three layers of the wall and a periaortic collection is formed?
What is the most common location of thoracic aortic aneurysms?
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What is the age range with the highest predilection for thoracic aortic aneurysms?
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What is the term for an aneurysm that involves only a portion of the aortic wall?
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What is the term for an aneurysm that involves the entire circumference of the aorta?
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What is the term for a dissecting aneurysm?
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What is the most common cause of Abdominal Aortic Aneurysm?
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What is the gold standard for the diagnosis of aneurysms and dissections?
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What is the primary advantage of using Ultrasound in diagnosing Abdominal Aortic Aneurysm?
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What is the term for the separation of the aortic intima with a tear in it, communicating with the true lumen?
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What is the primary complication of Abdominal Aortic Aneurysm?
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What is the purpose of pre-operative assessment of AAA?
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What is the term for the curvilinear calcification seen on plain film in abdominal aortic aneurysm?
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What is the alternative to CT/CTA in patients with impaired renal function or allergy to contrast?
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Study Notes
Aneurysms
- An aneurysm is an abnormal dilatation of a blood vessel caused by the weakening of the blood vessel wall.
Causes of Aneurysms
- Atherosclerosis
- Hypertension
- Inflammatory/Arteritis
- Connective Tissue diseases (e.g. Marfan's, Ehlers-Danlos)
- Smoking
- Infections
- Pregnancy
- SLE
- Trauma
Maximum Normal Aortic Diameter
- Ascending aorta: 4 cm
- Descending aorta: 3 cm
- Abdominal aorta: 2 cm
Classification of Aortic Aneurysms
- True aneurysms: all three layers of the wall are affected and the ballooning is contained in them
- False aneurysms: tear through all three layers of the wall and a periaortic collection is formed, contained by the extra vascular connective tissue
- Dissecting aneurysms: tear through the tunica intima, causing blood collection in between the layers
- True aneurysms can be further divided into:
- Fusiform aneurysm: circumferential involvement of the aorta
- Saccular aneurysm: only a portion of the wall is involved
Thoracic Aortic Aneurysm
- Aneurysmal dilatation of the ascending, descending, or arch of the aorta
- Anatomical classification:
- Aneurysm of sinus of Valsalva: congenital, syphilis
- Ascending aorta: atherosclerosis, Marfan syndrome, Ehlers-Danlos syndrome, syphilis, Mycotic
- Arch of aorta: atherosclerosis
- Descending aorta, aortic isthmus: post-traumatic aneurysm, atherosclerosis
Clinical Presentation of Thoracic Aneurysms
- Substernal, back, and/or shoulder pain
- Dysphagia
- Stridor
- Dyspnea
- Voice hoarseness (due to recurrent laryngeal nerve compression)
Imaging of Thoracic Aneurysms
- CHEST X-RAY: widening of mediastinal silhouette, enlargement of aortic knob, displacement of trachea/esophagus from the midline, calcification in cases caused by atherosclerosis
- CT/CT Angiography: gold standard for diagnosis of aneurysms and dissections, measures maximum size, and monitors diameter change over time
- MR/MRA: alternative to CT/CTA, especially in patients with impaired renal function and allergy to contrast
- Aortography: rarely used nowadays, precise definition of anatomy of aneurysm and great vessels
Causes of Abdominal Aortic Aneurysm
- Atherosclerosis (70-90%)
- Traumatic (15-20%)
- Congenital (2%)
- Syphilis
- Mycotic
- Inflammation of media and adventitia (Takayasu arteritis, Rheumatic fever, RA, AS, Reiter syndrome)
Imaging of Abdominal Aortic Aneurysm
- Plain Film: curvilinear mural calcification
- Ultrasound: advantages include availability, speed, low cost, and no radiation, disadvantages include affected view in obese patients, bowel gases, and proximal iliac arteries, findings include focal dilatation beyond normal and any increase in size of aorta that travels distally is abnormal
Complications of Abdominal Aortic Aneurysm
- Rupture (25%)
- Peripheral embolization
- Infection
- Spontaneous occlusion of aorta
- Pseud-aneurysm
- Compression of adjacent structures
Pre-operative Assessment of AAA
- Maximum diameter of the aneurysm
- Proximal and distal extent of aneurysm
- Assessment of iliac and renal arteries
- Peri aneurysmal fibrosis
- Congenital variation: accessory renal artery, retro aortic course of left renal vein
- CT/CTA is required for assessment, US alone is not enough
Aortic Dissection
- Separation of the aortic intima with a tear in it, communicating with the true lumen
- True lumen: inside the intima
- False lumen: outside the intima
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Description
This quiz covers the definition, causes, and classification of aneurysms, including the abnormal dilatation of blood vessels and their underlying factors. It also touches on the normal diameter of different aortic segments.
