Thoracic Aortic Disease & Vasculitides Flashcards
What are the different locations or classes of thoracic aneurysm? [3]
Ascending Aorta
Aortic Arch
Descending Aorta (After that your into Abdominal Aorta)
What are the types of aneurysm? [2]
True & False True aneurysms are split into saccular & fusiform
What is a true aneurysm? [1]
Where all 3 layers of aortic wall are dilated.
One side = Saccular
All around = Fusiform
What is a false aneurysm? [2]
Some or all of the wall layers rupture. [1]
The haematoma is contained by the intact adventitia or surrounding soft tissue [1]
What causes an aneurysm? Differentiate between true [5] and false [3]
True:
- Atherosclerosis
- Connective Tissue Diseases (e.g. Marfan’s)
- Trauma
- Congenital Bicuspid Aortic Valve
- Infections e.g. Syphilis
False:
- Inflammatory Conditions (E.g. Takayasu’s Arteritis)
- Trauma
- Iatrogenic
Risk factors for an aneurysm [5]
Age
Smoking
Marfan’s etc.
Family History
Hypercholesterolaemia
Hypertension
What are the symptoms of a thoracic aortic aneurysm? [6]
They vary with location and are often asymptomatic: [1]
- SOB
- HF (if causing AR)
- Dysphagia/Hoarseness (If chronic asc. aortic aneurysm)
- Sharp Chest Pain radiating to Central upper back (spreads if dissection)
- Regional Hypotension
What are the clinical signs of a FALSE aneurysm? [3]
Thrill - Bruit - Pulsatile mass
What are the possible outcomes/complications of an aneurysm? [3]
- Rupture
- Ischaemia/Infarction
- Distal Emboli causing their own infarctions
What is Takayasu’s Arteritis? [3]
Takayasu’s arteritis is a large vessel granulomatous vasculitis.[1] It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse. [1] It is more common in females and Asian people [1]
Presentation of takayasu’s arteritis [5]
- systemic features of a vasculitis e.g. malaise, headache
- unequal blood pressure in the upper limbs
- carotid bruit
- intermittent claudication
- aortic regurgitation (around 20%)
How do we treat Takayasu’s Arteritis? [2]
Steroids & Surgery
Investigation of TAAs [5]
Bloods:
- FBC, clotting, U&E and creatinine, CRP, LFTs, amylase, syphilis and HIV serology, connective tissue disease genetic testing
ECG
Echo:
- TTE to view aortic valve and root, TOE to view from valve to proximal descending aorta
USS abdo:to look for associated abdo aneurysms
CT with contrast
Management of TAAs [5]
Surgery :thoracotomy with Dacron graft +/- aortic root or valve replacement
Medical:
- 6 monthly CT or MRI of aneurysm
- BP control with beta blockers (reduce shear stress across aortic wall)
- smoking cessation
- mx of underlying cause, mx of other cardiac RFs
What are indications for surgical intervention of TAA [2]
symptomatic or asymptomatic and >5.5cm (ascending aorta) or >6cm (descending aorta)
In TAA ruptures, what can happen and how will this affect clinical presentation [6]
Erosion into nearby structures:
- Haematemesis (aorto-oesophageal fistula)
- Haemoptysis (aorto-bronchial fistula)
- Haemothorax
- Cardiac tamponade (ruptures into pericardium)
- Acute L>R shunt (aorto-pulmonary artery fistula)
Management in TAA rupture [4]
IV access and bloods:FBC, clotting, U&E and creatinine, LFT, Cross Match
Immediate surgical repair:
- thoracotomy with Dacron graft +/- aortic root
- or valve replacement
- aim is the secure proximal aortic control without disturbing any tamponade effect provided by extra-aortic structures or haematoma
Vasculitides are categorised into large vessel [2], medium vessel [2] and small vessel [3]
Large vessel
- temporal arteritis
- Takayasu’s arteritis
Medium vessel
- polyarteritis nodosa
- Kawasaki disease
Small vessel
- ANCA-associated vasculitides (Wegener’s*, Churg-Strauss*, microscopic polyangiitis)
- Henoch-Schonlein purpura
- cryoglobulinaemic vasculitis
What are the vasculitides?
The vasculitides are a group of conditions characterised by inflammation of the blood vessel walls. This may, in turn, compromise vessel integrity. Constitutional symptoms may be present.
Buergers disease definition [2]
Epidemiology
Presentation [2]
Investigation
Affects large and medium sized arteries. Segmental thrombotic occlusions of lower limb vessels
Ep: Commonest in young male smokers
Presentation
- Proximal pulses usually present, but pedal pulses are lost
- An acuter hypercellular occlusive thrombus is often present
Ix: Tortuous corkscrew shaped collateral vessels may be seen on angiography
Giant cell arteritis definiton [1]
Epidemiology
Which is the most commonest type?
Investigation
Systemic granulomatous arteritis that usually affects large and medium sized vessels
Ep: F>M
Temporal arteritis is commonest type
Granulomatous lesions may be seen on biopsy (although up to 50% are normal)
Polyarteritis nodosa definition [1]
Epidemiology/risk factor
Associated with…
Ix
Systemic necrotising vasculitis affecting small and medium sized muscular arteries
Most common in populations with high prevalence of hepatitis B
Renal disease is seen in 70% cases
Angiography may show saccular or fusiform aneurysms and arterial stenoses
Wegeners granulomatosis definition
Which classification of vasculitides is this in?
Presentation
Investigation
Systemic necrotising granulomatous vasculitis
Predominantly affects small and medium sized arteries
Presentation: Cutaneous vascular lesions may be seen (ulceration, nodules and purpura)
Ix: Sinus imaging may show mucosal thickening and air fluid levels
