Aortic aneurysms and miscellaneous disorders

Question 1

thoracic aortic aneurysm

Answer 1

> 4cm in ascending

>3 cm in descending

Question 2

causes of aortic aneurysm

Answer 2

atherosclerosis, connective issue disorder, bicuspid aortic valve, vasculitis (Takayasu, giant cell, akylosing spondylitis, relapsing polychondritis), cystic medial necrosis, infectious aortitis

Question 3

annuloaortic ectasia

Answer 3

dilated sinuses of Valsava and ascending aorta with effacement of sinotubular junction; tulip bulb shaped aorta

Question 4

treatment for ascending thoracic aortic aneurysm

Answer 4

> 5.5 cm in diameter in ascending
6 cm in descending

lower threshold >4.5 cm with connective tissue disorders or bicuspid aortic valve or if annual growth rate >1 cm/yr

Question 5

draped aorta sign

Answer 5

drooping posterior aorta against spine

sign of impending rupture

Question 6

complications of TAA treatment

Answer 6

rupture, dissection, infection, endoleak, paraplegia (artery of Adamkiewicz occlusion)

Question 7

abdominal aortic aneurysm

Answer 7

> 3cm

Question 8

guidelines to monitor aneurysm

Answer 8

<4 cm: f/u in 6 months; anual surveillance

4-4.6: f/u 6 months, if no change 6 mo surveillance

5-5.5 cm: consider surgery

> 5.5 cm: surgery

Question 9

endoleak

Answer 9

persistent flow into excluded aneurysm sac after endovascular treatment with stent graft

Question 10

Type I endoleak

Answer 10

inadequate graft seal; IA proximal leak, IB distal leak

Question 11

type II endoleak

Answer 11

persistent collateral flow to excluded leak

usually lumbar arteries or IMA

Question 12

type III endoleak

Answer 12

device failure causing leakage

Question 13

type IV/V endoleak

Answer 13

no endoleak seen on imaging; diagnosis of exclusion

IV: porous graft; transient, usually resolves; not seen with modern grafts

V: endotension; expansion of aneurysm without any other endoleak present

Question 14

aortitis

Answer 14

Takayasu, giant cell arteritis, ankylosing spondylitis, polyarteritis nodosa, rheumatoid arthritis, immune complex disease

may result in mycotic aneurysm

Question 15

imaging of aortitis acute/chronic

Answer 15

acute: circumferential mural thickening/enhancement; aneurysm/dissection/IMH

wall thickness >2mm and enhancement on MRI

chronic: long segmental stenoses/aneurysm

Question 16

takayasu arteritis

Answer 16

idiopathc, inflammatory large vessel vasculitis; pulseless disease

young to middle aged women

long smooth stenoses (appears similar to giant cell arteritis)

treat with steroids; ESR elevated

Question 17

aortic coarctation

Answer 17

congenital focal narrowing of proximal descending aorta

collaterals develop in internal thoracic to epigastric and intercostal arteries

Question 18

juxtaductal vs preductal aortic coarctation

Answer 18

juxtaductal: adult form; junction of ductus arteriosus
preductal: infant; left ventricular obstructive lesion > CHF

Question 19

3 sign of left upper heart border

Answer 19

coarctation; double bulge from focal aortic narrowing and post stenotic dilation

rib notching seen

Question 20

measure flow across coarctation

Answer 20

phase contrast MRI