IR Flashcards
Most common site of traumatic aortic injury?
Root, however most of these patients die at the scene. Most common site diagnosed on imaging is at the isthmus, just distal to the origin of the left subclavian.
67 year old female. Diagnosis?
Giant cell arteritis.
(Angiographically identical to Takayasu’s arteritis, which is more common in patients <30)
What is giant cell arteritis?
What demographic?
What vessels?
Complication?
Generalized vasculitis of medium and large arteries. Granulomas on histology.
It is the most common primary vasculitis in people > 50. More common in women.
Aortic arch and extracranial carotid arteries. Rarely involves distal aorta.
If left untreated, can lead to vision loss. Treat with steroids.
What is Takayasu’s arteritis also called?
Demographic most commonly affected?
Obliterative brachiocephalic arteritis.
Can occur in anyone, but more common in women in the 2nd and 3rd decades of life.
Angiographic findings of Takayasu’s arteritis?
Classification?
Complication?
Treatment?
Long, smooth stenotic segments of medium and large arteries.
Divided into systemic phase and late occlusive phase. Also: type 1 (aortic arch and great vessels), 2 (distal thoracic and abdominal aorta), 3 (arch and abdominal aorta), 4 (any type + pulmonary arteries).
Cerebral ischemia.
Steroids.
Key feature of a mycotic aneurysm?
Cause?
Rapidly developing. Wall should not be calcified.
Infection within the aortic wall leads to aortic degeneration and rapid growth of an aneurysm.
Typical site for primary aortoenteric fistula?
Communication between the infrarenal aorta and the 3rd or 4th portion of the duodenum.
Classic triad of aortoenteric fistula (seen in <30% of cases)?
GI bleeding, sepsis, and abdominal pain.
How long is air and fluid around a prosthetic arterial graft considered to be normal?
6-7 weeks post op. Later, indicates infection.
What is the difference between subclavian steal syndrome and phenomenon?
SS syndrome: retrograde vertebral artery flow associated with transient neurologic symptoms related to cerebral ischemia (commonly dizziness, vertigo, visual changes).
SS phenomenon: asymptomatic regrograde flow in the vertebral artery. If asymptomatic, there is no indication for treatment.
Diagnosis?
Imaging features?
Carotid body glomus tumor (carotid body paraganglioma). Sporadic or hereditary (AD. Assoc with MEN 2a and 2b, TS, NF1, VHL, carney triad). Only 6-12% are malignant. May cause HTN, palpitations, flushing due to norepinephrine. Can be moved side to side but not up and down due to location.
Imaging: Splaying of ICA and ECA. Intense enhancement. MR: salt and pepper. DSA: hypervascular (blood supply typically from ascending pharyngeal artery). Uptake with MIBG and octreoscan.
Differential includes neurogenic tumor from the carotid sheath contents.
In which patients will lytic therapy work best?
When is it contraindicated?
Patients with acute limb ischemia should be evaluated clinically. They are good candidates for lytic therapy if the tissue is viable or accutely threatened. In patients with immediately threatened tissue (mod sensory loss, mild-mod weakness)- lytic therapy only if poor operative candidate. Irreversible damage (no cap return, projound sensory loss, paralysis)- go to surgery. Lytics work best in acute (<14 days) thrombus.
Contraindications to lytics: active bleeding, recent stroke, recent surgery, brain tumor.
What are the indications for renal artery revascularization?
Documened stenosis and a significant sign such as hypertension, flash pulmonary edema, or an elevated Cr level. Patients with Cr > 3 have a worse prognosis and a poor response to treatment.
Best treated with primary stent placement (balloon-expandable).
Criteria for intervention in patients with PE?
Options?
Hypotension, RV failure, need for intubation.
Therapeutic options: systemic anticoagulation, systemic thrombolysis, thrombectomy, catheter-directed thrombolysis (alteplase 0.25-2 mg/h).
Diagnosis?
Presentation?
May-Thurner syndrome- compression of the left iliac vein by the right common iliac artery.
Presentation- isolated left lower extremity DVT or swelling.
Treatment- placement of a self-expandable stent.
What is the systolic pressure gradient for a lesion to be considered hemodynamically significant arterial stenosis?
> 10 mmHg at rest
Indications for treatment of a AAA?
Diameter > or = 5 cm (risk of rupture of a 5 cm aneurysm is 50% w/in 5 yrs).
Growth of > 0.5 cm within 6 months.
Symptomatic (abdominal/back pain not explained by another condition).
Diagnosis?
Budd-Chiari syndrome. Spider ewb appearance of the hepatic veins.
Diagnosis?
Presentation?
Acute portal vein thrombosis.
May present with severe abdominal pain, liver failure, portal HTN, or GI bleeding. Prompt anticoagulation, thrombolysis, thrombectomy to prevent complications.
Predisposing factors- primary coagulopathy, neoplasm, sepsis, hypovolemia, post-surgical, post-trauma.
Diagnosis?
Complication?
Aberrant right subclavian artery (this is the “bayonet deformity”).
Aneurysmal dilatation of the proximal portion of an aberrant right subclavian artery can occur, a pouch like aneurysmal dilatation is called a diverticulum of Kommerell.
Post liver transplant. Diagnosis?
Biliary cast syndrome. Rare complication post-liver transplant, likely seccondary to the accumulation of biliary sludge in the bile ducts.
Differential includes stones, clots.
What complication has occurred during hepatic vein wedge injection?
Capsular perforation, maybe due to forceful injection. This is a possible fatal complication of TIPS or transjugular liver biopsy. Embolize tract. Monitor patient for 24-48 hours post procedure.
Cause for GI bleeding in this patient?
Colonic angiodysplasia.
Angiographic appearance- vascular tuft with an early draining vein. Acquired lesions in patients over 60, most common in cecum, commonly multiple.
Diagnosis?
What is this?
Who?
Cystic adventitial disease of the popliteal artery. MRI demonstrates multiple arterial intramural cystlike masses.
Cystic adventitial disease is cystic degeneration of a peripheral artery, most common in the popliteal. Cysts are filled with thick mucinous gel. Surgical excision recommended.
Typically in young to middle aged patients w/o atherosclerosis. Present with sudden onset of calf claudication and leg pain.
20F with post-prandial abdominal pain. Diagnosis?
Complications?
Median arcuate ligament syndrome.
Untreated MALS can lead to fixed stenosis, aneurysm, or complete occlusion of the celiac. If complete occlusion, there is resultant enlargement of the pancreaticoduodenal collaterals to supply the celiac distribution, which can lead to aneurysms. Aneurysms fo the pancreaticoduodenal arteries have a high risk for rupture (should be coiled if present).
Diagnosis?
Cause?
Presentation?
Hypothenar hammer syndrome.
Injury to the ulnar artery as it passes over the hamate bone (Guyon’s canal). Usually due to repetitive occupational trauma.
Presentation- numbness of the 4th-5th digits, ischemia in cases of incomplete palmar arches or distal emboli.
