Risk Factors, Presentations, Diagnosis and Treatment of Aortic Disasters
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Risk Factors, Presentations, Diagnosis and Treatment of Aortic Disasters
- 1. AORTIC DISASTERS Ahmed Alhubaishi R3
- 10. Stanford type B or DeBakey type III dissection distal to the subclavian artery
- 14. KLOMPAS M. DOES THIS PATIENT HAVE AN ACUTE THORACIC AORTIC DISSECTION? J AM MED ASSOC 2002
- 17. Characteristics of Aortic Dissection from the International Registry of Acute Aortic Dissection [4] LEFT VENTRICULAR HYPERTROPHY (%) ISCHEMIA (%) NORMAL ECG (%) WIDENED MEDIASTINUM ON CXR (%) NORMAL CXR (%) PULSE DEFICIT (%) AORTIC INSUFFICiENCY MURMUR (%) SYNCOPE (%) CHEST PAIN (%) 26 15 31 62 12 15 32 9 73 All ( n = 464) 25 17 31 63 11 19 44 13 79 Type A ( n = 289) 32 13 32 56 16 9 12 4 63 Type B ( n = 175)
- 20. KLOMPAS M. DOES THIS PATIENT HAVE AN ACUTE THORACIC AORTIC DISSECTION? J AM MED ASSOC 2002
- 29. -- Sensitivities and Specificities of Imaging Modalities for Diagnosing Aortic Dissection ( From Shiga T, Wajima Z, Apfel CC, et al: Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: Systematic review and meta-analysis. Arch Intern Med 166:1350–1356, 2006 .) MRI HELICAL CT TEE TEST 98 100 98 Sensitivity (%) 98 98 95 Specificity (%)
- 32. Computed tomography scan demonstrating the true lumen and false lumen
- 42. HAGAN P, NIENABER CA, ISSELBACHER EM, ET AL. THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD): NEW INSIGHTS INTO AN OLD DISEASE. J AM MED ASSOC 2000 Pitfall : Use of the chest X-ray to exclude the diagnosis of AD
- 54. Types of aortic aneurysms
- 57. Table 84-1 -- Prevalence of Abdominal Aortic Aneurysms (AAAs) in Selected Risk Groups INCIDENCE (%) GROUP 2–4 Autopsy subjects aged 50 years or old 5,6] 5–10 Men aged 65 years or older [4,7] 10–15 Patients with coronary artery disease [8] or occlusive peripheral vascular disease [9,10] 20–30 Brothers of patients with AAAs [11,12]
- 64. Anteroposterior ( A ) and lateral ( B ) views of large abdominal aortic aneurysms with calcification of the aortic wall
- 66. Cross-sectional ultrasound of a 6-cm abdominal aortic aneurysm. Note mural thrombus and eccentrically shaped patent lumen .
- 70. Computed tomography scan of ruptured abdominal aortic aneurysm, with calcification of the aortic wall and intraluminal thrombus. The patent lumen enhances with the administration of contrast material, but the periaortic hematoma ( arrow ) does not .
Notas del editor
- The aorta is composed of three layers, the intima (inner most layer), media, and adventitia. Aortic dissection occurs when a tear forms between the layers of the aortic wall. Blood can then dissect and travel down the length of the aorta.
- • Hypertension (only ~ 50% are hypertensive on presentation)-most common risk factor • Male sex • Age (tends to occur in older patients, but don’t forget that young patients can develop TAD as well.) • Pregnancy (also a risk factor for coronary artery dissection) • Family history (not connective-tissue disease related) • Connective tissue disease (Marfans and Ehler-Danlos) ------------------------------------------------------------------------ Less Common Risk Factors: • Cocaine (Type B more common) • Turner’s syndrome • Bicuspid aortic valve • Iatrogenic (cardiac catheterization) • Coarctation of the aorta • Trauma • Ecstasy (NMDA) use and weight lifters-associated TAD
- CXR will be abnormal in 80-90% of cases Mediastinal widening- in 75% Hard to tell from tortuosity in chronic hypertension “ Calcium sign”- uncommon but highly specific intimal calcification >5 mm separated from outermost part of aorta Aortic double density Disparity in caliber between ascending and descending aorta Localized bulge on the aorta Obliteration of the aortic knob NG tube, trachea or ETT displaced to the right Pleural effusions- common and usually on the left Large effusions should cause suspicion of a leak or rupture