Vascular Flashcards
What are the imaging findings in traumatic aortic injury?
CXR shows widened mediastinum, NGT deviation, left apical cap; CTA shows pseudoaneurysm or dissection flap.
How is ductus diverticulum differentiated from pseudoaneurysm?
Ductus diverticulum has a gentle obtuse angle and calcifications, while pseudoaneurysm has an acute angle and no calcifications.
What defines a true aneurysm?
Enlargement of the lumen to 1.5 times its normal diameter with all three layers intact.
What are the imaging criteria for thoracic aortic aneurysm repair?
Ascending TAA >5.5 cm, descending TAA >6 cm, or annual growth >1 cm.
What gene mutation is associated with Marfan syndrome?
Mutation of the fibrillin gene.
What is the tulip bulb sign?
Imaging feature of Marfan syndrome indicating annuloaortic ectasia.
What is the most common location for abdominal aortic aneurysm?
Infra-renal region.
What is the mortality rate for ruptured abdominal aortic aneurysms?
Approximately 50%.
What are Type III and IV endoleaks?
Type III: Device failure causing leakage; Type IV: Porous graft leading to transient leakage.
What is endotension?
Type V endoleak below imaging resolution with sac expansion.
What are the types of coarctation of the aorta?
Preductal (infantile) and juxtaductal (adult).
What is the coronary dominance in most people?
Right coronary artery dominance (85%).
What is the clinical importance of high take-off coronary ostia?
Can complicate cannulation during coronary arteriography.
What is the ramus intermedius artery?
A variant branch of the left main coronary artery, present in 20% of cases.
What is the imaging modality of choice for coronary artery anomalies?
Coronary CTA.
What is the coronary steal phenomenon?
Reversed flow from the left coronary artery into the pulmonary trunk in ALCAPA.
What are the imaging findings of pulmonary embolism?
Hampton hump (wedge-shaped opacity) and Westermark sign (oligemia).
What are the symptoms of subclavian steal syndrome?
Arm claudication and posterior neurological signs due to reversed vertebral artery flow.
What is the imaging finding in Dunbar syndrome?
Focal stenosis with a hooked appearance of the celiac trunk.
What are the clinical signs of Nutcracker syndrome?
Hematuria, left testicular pain, and left flank pain.
What is the imaging feature of fibromuscular dysplasia?
Beaded appearance sparing the ostium.
What distinguishes thoracic from abdominal aortic aneurysms?
Thoracic aneurysms are >4 cm in the ascending aorta or >3 cm in the descending aorta; abdominal aneurysms are >3 cm.
What is the imaging sign for rib notching in coarctation of the aorta?
Notching of the 4th to 8th ribs due to collateral vessel enlargement.
What is the imaging appearance of the 3 sign in coarctation?
Double bulge caused by stenosis and post-stenotic dilatation.
What artery supplies the posterior descending artery in left-dominant hearts?
Left circumflex artery.
What is the cobweb sign in aortic dissection?
Thin linear structures within the false lumen indicating septation.
What imaging modality is preferred for traumatic aortic injury?
CT angiography.
What is Leriche syndrome?
Aortoiliac occlusion presenting with impotence, gluteal claudication, and absent femoral pulses.
What is the cause of May-Thurner syndrome?
Compression of the left common iliac vein by the right common iliac artery.
What is the beak sign in aortic dissection?
Acute angle formed by the intimal flap in the false lumen.
What is the treatment for Type I endoleaks?
Emergent repair due to inadequate graft sealing.
What is the difference between Type IA and Type IB endoleaks?
Type IA: proximal graft leak; Type IB: distal graft leak.
What imaging modality best evaluates coronary artery anomalies?
Coronary CTA.
What is the imaging hallmark of Takayasu arteritis?
Wall thickening and enhancement in the acute phase; long smooth stenosis in the chronic phase.
What is the hallmark of giant cell arteritis?
Temporal artery involvement with vessel wall thickening.
What is the classic appearance of Marfan syndrome on imaging?
Annuloaortic ectasia with a tulip bulb configuration.
What is the most common risk factor for aortic dissection?
Hypertension.
What is the most common source of pulmonary embolism?
Thrombi from the deep veins of the leg.
What is the imaging feature of the crescent sign in intramural hematoma?
Hyperattenuating crescent within the aorta on non-contrast CT.
What is the most common vasculitis?
Giant cell arteritis.
What is the imaging hallmark of the Westermark sign?
Focal oligemia seen in pulmonary embolism.
What is the characteristic imaging feature of the Hampton hump?
Peripheral wedge-shaped opacity in pulmonary embolism.
What is the natural history of abdominal aortic aneurysm?
Progressive enlargement and rupture.
What is the first-line treatment for subclavian steal syndrome?
Bypass surgery.
What is the most common cause of renal artery stenosis?
Atherosclerosis.
What is the common origin variant of the aortic arch?
Shared origin of the brachiocephalic and left common carotid arteries (13%).
What percentage of people have a left-dominant coronary circulation?
0.07
What are the surgical criteria for abdominal aortic aneurysm repair?
Diameter >5.5 cm, annual growth >5 mm, or symptomatic aneurysms.
What is the imaging hallmark of the draped aorta sign?
Posterior wall of the aneurysm drapes over the vertebra in a contained rupture.
What is the most common cause of thoracic aortic aneurysm?
Atherosclerosis.
What is the most common imaging modality for AAA follow-up?
Ultrasound for surveillance of aneurysm size.
What is the most common complication after EVAR?
Endoleaks, with Type II being the most frequent.
What are the key imaging modalities used in vascular imaging?
Conventional imaging, CT angiography, MR angiography, and ultrasound, each with specific indications, advantages, and disadvantages.
What are the segments of the aorta?
Thoracic (aortic root, ascending, arch, descending) and abdominal (suprarenal, infrarenal).
Name the parts of the thoracic aorta.
Aortic root, aortic annulus, sinus of Valsalva, and sinotubular junction.
What is the sinus of Valsalva and its cusps?
It has three cusps: right, left, and non-coronary.
What is the most common configuration of the aortic arch?
Usual configuration (66%) with branches: innominate artery, left common carotid artery, and left subclavian artery.
What are the imaging findings in an aberrant right subclavian artery?
Posterior indentation of the esophagus on a barium swallow.
Define acute aortic syndrome and its components.
It includes penetrating atherosclerotic ulcer, aortic dissection, and intramural hematoma.
What are the imaging findings for a penetrating atherosclerotic ulcer?
Contrast ulcerating beyond the expected contour of the aortic wall.
What causes an intramural hematoma?
Defect in the tunica media, rupture of vasa vasorum, associated with hypertension.
How is aortic dissection classified?
Stanford (Type A and B) and DeBakey classifications.
What is the difference between true and false lumens in aortic dissection?
True lumen: smaller, calcified borders. False lumen: larger, cobweb sign, beak sign.
What is the most common cause of thoracic aortic aneurysm?
Atherosclerosis.
What imaging sign indicates a contained rupture of an aneurysm?
Draped aorta sign.
What are the recommendations for abdominal aortic aneurysm surgery?
Diameter >5.5 cm, annual growth >5 mm, or symptomatic cases.
What is EVAR and its indication?
Endovascular aortic repair, indicated for AAA >5 cm or rapid growth (5 mm in 6 months).
What is the most common type of endoleak after EVAR?
Type II endoleak, caused by persistent collateral flow.
What differentiates Takayasu arteritis from giant cell arteritis?
Age group: Takayasu affects young women, giant cell arteritis affects older men.
What imaging feature is seen in coarctation of the aorta?
3 sign on imaging and rib notching.
What are the branches of the subclavian artery (mnemonic: VIT C, D)?
Vertebral, internal thoracic, thyrocervical, costocervical, and dorsal scapular arteries.
What is a malignant coronary artery anomaly?
An interarterial course of a coronary artery that increases the risk of sudden death.
What is the cause of ALCAPA syndrome?
Anomalous left coronary artery from the pulmonary artery causing coronary steal phenomenon.
What are the signs of pulmonary embolism on imaging?
Hampton hump (wedge-shaped density) and Westermark sign (oligemia).
What causes subclavian steal syndrome?
Arteriosclerotic plaque at the subclavian artery origin causing vertebral artery flow reversal.
What is Dunbar syndrome?
Compression of the celiac artery by the median arcuate ligament, seen as focal hooked stenosis.
What imaging finding is seen in Nutcracker syndrome?
Reduced aortic-SMA angle and renal vein stenosis.
What are the causes of renal artery stenosis?
Atherosclerosis (75%, near the ostium) and fibromuscular dysplasia (beaded appearance).
What is the triad of Leriche syndrome?
Impotence, gluteal claudication, and absent femoral pulses.
What causes May-Thurner syndrome?
Compression of the left common iliac vein by the right common iliac artery.
