Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘aorta’ Category

May-Thurner syndrome

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  • DVT of left ileofemoral vein by compression of left common iliac vein from overlapping right common iliac artery

Written by lmwong

February 6, 2010 at 1:36 pm

Right Aortic Arch

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Type 1 = Mirror Image
  • ~congenital heart abnormalities
  • arch descends on right
  • trachea

Type 2 = Aberrant Left Subclavian Artery

  • retroesophageal compression
  • dilateral subclavian artery = Kommerell diverticulum

Written by lmwong

January 24, 2010 at 3:57 pm

Double Aortic Arch

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  • persistent right and left 4th aortic arches
  • anterior compression of trachea
  • posterior compression of esophagus
  • determine dominant arch for surgical planning

Written by lmwong

January 24, 2010 at 3:12 pm

Traumatic Aortic Transection

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  • 3 most common places
    • ligamentum arteriosum
    • aortic root
    • diaphragm
  • blunt chest trauma, high mortality; 50% who present will die within 24 hour
  • mediastinal hemorrhage
  • deformed aortic contour
  • intimal flap
  • intraluminal clot or debris
  • pseudoaneurysm
  • frank extravasation of contrast

Written by lmwong

January 13, 2010 at 1:38 am

Posted in aorta, chest, trauma

Aberrant right subclavian artery

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  • most common vessel branching anomaly, 1% of population
  • left arch (always opposite of aberrant vessel)
  • POSTERIOR extrinsic filling defect in esophagus (vs ANTERIOR = double arch)
  • right aberrant vessel last branch of arch, the right carotid will be first branch

Written by lmwong

January 9, 2010 at 12:57 am

Takayasu’s arteritis

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  • described by Dr. Takayasu, opthalmologist, who described retinal vascular malformations caused by stenosis of neck arteries
  • inflammation and fibrosis of aorta and major branches
  • female patients, 80% of Asian descent, younger than 30 yo.
  • Stage I: systemic, fever, arthralgias, weight loss
  • Stage II: fibrotic changes, vessel stenosis and aneurysmal formation
  • elevated ESR and thrombocytosis
  • treated with steroids
  • death from CHF, arrhythmias, stroke

Written by lmwong

June 5, 2008 at 7:23 pm

Posted in aorta, chest

Aortic Dissection

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Stanford Type A = involves ascending aorta > surgery *
Stanford Type B = only descending aorta > medical

DeBackey Type I = ascending + descending *
DeBackey Type II = ascending only *
DeBackey Type IIIa = descending only
DeBackey Type IIIb = descending, including abdominal

*Requires surgery = anything involving ascending aorta

  • Causes
    • HTN, Marfan, Ehlers-Danlos syndrome, pregnancy, trauma, aortic valve disease and CABG
  • most commonly tears 2-3cm from aortic valve
  • die of tamponade, valvular insufficiency, coronary artery occlusion


  • Widened mediastinum
  • “calcium sign”
  • Obscured left heart border
  • Hazy aortic knob
  • 20-25% chest films are normal

CT with contrast (GOLD)

  • intimal flap
  • true vs false lumen, note which vessel branches take off from the false lumen, involvement of aortic arch branches
  • Aortic root involved? AI?
  • Tamponade?
  • Dissect into coronaries

Written by lmwong

June 5, 2008 at 1:59 pm

Posted in aorta, chest, trauma

Aortic Aneurysm

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Types by location

  • Aortic Root
  • Thoracic
  • Abdominal (most common); infrarenal 95%


  • Root
  • Ascending
  • Proximal descending
  • Distal descending
  • Abd


  1. ASD (80-90%) = fusiform
  2. Traumatic (15-20%)
  3. Congenital (2%)
  4. Infection (saccular): Syphilis, Mycotic
  5. Marfan, Ehlers-Danlos syndrome, annuloaortic ectasia
  6. Inflammatory: Takayasu, giant cell arteritis, relapsing polychondritis, rheumatic fever, RA, RF negative spondyloarthropathies, SLE, scleroderma, Behcet disease, radiation
  7. Increased pressure: HTN, aortic stenosis
  8. Increased volume: aortic regurgitation
  9. cystic medial necrosis = ascending aorta

True vs Flase: A true aneurysm dilates all walls but is contained within intact wall. In a false aneurysm, the wall is distrupted and the blood escapes but contained with adventetia/connective tissue.

Treatment: surgery is indicated if >5-5.5cm (abdominal).

Written by lmwong

April 14, 2008 at 1:44 pm