Contrast-Enhanced Magnetic Resonance Angiogram of Penetrating Aortic Ulcer
2001; Lippincott Williams & Wilkins; Volume: 103; Issue: 4 Linguagem: Inglês
10.1161/01.cir.103.4.e18
ISSN1524-4539
AutoresRaad Mohiaddin, Jane McCrohon, Jane M Francis, M. Barbir, Dudley J. Pennell,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoHomeCirculationVol. 103, No. 4Contrast-Enhanced Magnetic Resonance Angiogram of Penetrating Aortic Ulcer Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBContrast-Enhanced Magnetic Resonance Angiogram of Penetrating Aortic Ulcer R. H. Mohiaddin, J. McCrohon, J. M. Francis, M. Barbir and D. J. Pennell R. H. MohiaddinR. H. Mohiaddin From Royal Brompton and Harefield NHS Trust, London, UK. , J. McCrohonJ. McCrohon From Royal Brompton and Harefield NHS Trust, London, UK. , J. M. FrancisJ. M. Francis From Royal Brompton and Harefield NHS Trust, London, UK. , M. BarbirM. Barbir From Royal Brompton and Harefield NHS Trust, London, UK. and D. J. PennellD. J. Pennell From Royal Brompton and Harefield NHS Trust, London, UK. Originally published30 Jan 2001https://doi.org/10.1161/01.CIR.103.4.e18Circulation. 2001;103:e18–e19A 56-year-old man presented with sudden severe chest and back pain. His chest x-ray showed a slight prominence on the upper descending thoracic aorta. Aortic dissection (type B) was visible on transesophageal echocardiography and CT. Coronary angiography showed normal coronary arteries. MRI and contrast-enhanced magnetic resonance angiography (CE-MRA) confirmed the diagnosis of type B aortic dissection involving the distal aortic arch and descending aorta (Figure). In addition, the CE-MRA depicted an intramural hematoma in the outer curvature wall of the distal aortic arch and the proximal descending thoracic aorta, with a button-shaped focal signal enhancement that was consistent with a penetrating aortic ulcer. The arterial phase MRA showed the aortic ulcer and the true and false aortic lumina, with less contrast in the partially thrombosed false lumen and the intramural hematoma when compared with the late phase MRA. The patient was treated conservatively and is currently well and asymptomatic. To our knowledge, this is the first report of a penetrating aortic ulcer demonstrated by CE-MRA.A penetrating atherosclerotic ulcer of the descending thoracic aorta, which is a potentially fatal aortic catastrophe, is characterized on angiography by focal enhancement beyond the confines of the aortic lumen but communicating with the lumen.12 Because of the rare occurrence of aortic ulcers, the prognosis, outcome, and management of such patients are still not clear.13 Accurate diagnosis of penetrating aortic ulcers is sometimes difficult. CT may demonstrate the surrounding hematoma and displaced calcifications. MRI, including CE-MRA, is a versatile method for assessing aortic disease and seems well suited for the characterization of penetrating aortic ulceration. This is important because surgery to repair a penetrating ulcer requires more extensive aortic resection than does the repair of a dissection, and it involves placing a longer aortoaortic interposition graft in an atherosclerotic aorta that is often friable.2The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. CE-MRA (a, arterial phase; b, late phase) depicted intramural hematoma (IMH) in outer curvature wall of distal aortic arch and in proximal descending thoracic aorta, with button-shape focal signal enhancement (arrows) consistent with penetrating aortic ulcer. Arterial phase MRA showed aortic ulcer and true (t) and false (f) aortic lumina, with less contrast in partially thrombosed false lumen and intramural hematoma when compared with late phase MRA.FootnotesCorrespondence to Raad H. Mohiaddin, MD, PhD, MRCP, FRCR, FESC, Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. E-mail [email protected] References 1 Hussain S, Glover JL, Bree RL, et al. Penetrating atherosclerotic ulcers of the thoracic aorta. J Vasc Surg.1989; 9:710–717.CrossrefMedlineGoogle Scholar2 Kazeronni EA, Bree RL, Williams DM. Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. Radiology.1992; 183:759–765.CrossrefMedlineGoogle Scholar3 Cooke JP, Kazmier FJ, Orszulak TA. Penetrating aortic ulcer: pathologic manifestations, diagnosis and management. Mayo Clinic Proc.1988; 63:718–725.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Abbasi M, Pathrose A, Serhal A and Carr J (2020) Imaging Approaches for Aortic Disease Vessel Based Imaging Techniques, 10.1007/978-3-030-25249-6_10, (173-208), . Raptis C, Fowler K, Narra V, Menias C and Bhalla S (2014) Emergency Thoracic Vascular Magnetic Resonance Imaging: Protocols and Clinical Considerations, Seminars in Roentgenology, 10.1053/j.ro.2014.01.003, 49:2, (157-168), Online publication date: 1-Apr-2014. Ward E and Carr J (2012) Thoracic Aorta Magnetic Resonance Angiography, 10.1007/978-1-4419-1686-0_18, (239-252), . Tann O, Bogaert J, Taylor A and Muthurangu V (2011) Imaging of Great Vessels Clinical Cardiac MRI, 10.1007/174_2011_422, (611-656), . 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Carr J and Finn J (2003) MR imaging of the thoracic aorta, Magnetic Resonance Imaging Clinics of North America, 10.1016/S1064-9689(02)00027-2, 11:1, (135-148), Online publication date: 1-Feb-2003. Tsuji Y, Tanaka Y, Kitagawa A, Hino Y, Taniguchi T, Sugimoto K, Matsuda H and Okita Y (2003) Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta, Journal of Vascular Surgery, 10.1016/S0741-5214(03)00139-3, 38:2, (383-388), Online publication date: 1-Aug-2003. January 30, 2001Vol 103, Issue 4 Advertisement Article InformationMetrics Copyright © 2001 by American Heart Associationhttps://doi.org/10.1161/01.CIR.103.4.e18 Originally publishedJanuary 30, 2001 PDF download Advertisement
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