Produção Nacional
Revisado por pares
Acute Limited Intimal Tear of the Right Aortic Sinus
2021; Radiological Society of North America; Volume: 3; Issue: 6 Linguagem: Inglês
10.1148/ryct.210239
ISSN2638-6135
AutoresLucas de Pádua Gomes de Farias, Márcio Santos Sampaio, J. Fonseca, Luciana de Pádua Silva Baptista,
Tópico(s)Infectious Aortic and Vascular Conditions
ResumoHomeRadiology: Cardiothoracic ImagingVol. 3, No. 6 Previous Images in Cardiothoracic ImagingFree AccessVascular ImagingAcute Limited Intimal Tear of the Right Aortic SinusLucas de Pádua Gomes de Farias , Márcio Campos Sampaio, José Honório de Almeida Palma da Fonseca, Luciana de Pádua Silva BaptistaLucas de Pádua Gomes de Farias , Márcio Campos Sampaio, José Honório de Almeida Palma da Fonseca, Luciana de Pádua Silva BaptistaAuthor AffiliationsFrom the UnitedHealth Group Brazil, Hospital Samaritano Paulista, Avenida Brigadeiro Luís Antônio 1895, Bela Vista, São Paulo, SP 01317-002, Brazil.Address correspondence to L.d.P.G.d.F. (e-mail: [email protected]).Lucas de Pádua Gomes de Farias Márcio Campos SampaioJosé Honório de Almeida Palma da FonsecaLuciana de Pádua Silva BaptistaPublished Online:Dec 2 2021https://doi.org/10.1148/ryct.210239MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Limited intimal tears (LITs) are uncommon but potentially lethal lesions within the dissection spectrum, occurring in approximately 5% of patients presenting with acute aortic syndrome (1). LITs are classified as a "class 3 of intimal tear" and represented by intimomedial tears with an eccentric aortic wall bulge but without substantial hematoma (2). While the edges of an LIT can be undermined to a variable degree and filled with small amounts of blood or clot, there is no propagation of the dissection plane along the aorta and no exit tear and double-barrel flow channel as in classic aortic dissection (1,3). LITs may evade identification at transesophageal echocardiography or CT because of the limited extent of undermined intimal layers and a minimal amount of blood in the dissected aortic wall. This imaging pitfall can result in progression of dissection, cardiac tamponade, or aortic rupture causing potentially lethal outcomes (1,2,4). Furthermore, the diagnosis of LITs may be missed if conventional diagnostic criteria that are dependent on the presence of an intimal flap are applied (4). Awareness of this entity, high index of suspicion at CT angiography with use of appropriate reconstruction techniques for the aortic root may allow timely patient management (1) (Figure).Images in a 62-year-old man who presented to the emergency department with acute chest pain. (A) Short-axis view of the aortic root, (B) three-chamber view, (C–E) three-dimensional volume-rendered images, and (F) intraoperative view after median sternotomy with extracorporeal circulation show an eccentric bulge of the right aortic sinus (R) with the presence of a focal limited tear (arrowhead). This is represented by focal linear "flaps" with undermined edges, as a bandlike outpouching where the right coronary artery (RCA) took off. The patient underwent graft replacement of the ascending aorta and aortic valve replacement. AA = ascending aorta, LA = left atrium, LV = left ventricle, LM = left main artery, R/L/NC = right/left/noncoronary aortic sinus.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: L.d.P.G.d.F. No relevant relationships. M.C.S. No relevant relationships. J.H.d.A.P.d.F. No relevant relationships. L.d.P.S.B. No relevant relationships.Keywords: CT Angiography, Vascular, Aortic RootAuthors declared no funding for this work.References1. Chin AS, Willemink MJ, Kino A, et al. Acute limited intimal tears of the thoracic aorta. J Am Coll Cardiol 2018;71(24):2773–2785. Crossref, Medline, Google Scholar2. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010;55(14):e27–e129. Crossref, Medline, Google Scholar3. Murray CA, Edwards JE. Spontaneous laceration of ascending aorta. Circulation 1973;47(4):848–858. Crossref, Medline, Google Scholar4. Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation 1999;99(10):1331–1336. Crossref, Medline, Google ScholarArticle HistoryReceived: Sept 1 2021Revision requested: Sept 27 2021Revision received: Sept 29 2021Accepted: Nov 4 2021Published online: Dec 02 2021 FiguresReferencesRelatedDetailsRecommended Articles International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research PurposesRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 4Aortic Dissection and Other Acute Aortic Syndromes: Diagnostic Imaging Findings from Acute to Chronic Longitudinal ProgressionRadioGraphics2021Volume: 41Issue: 2pp. 425-446Multimodality Imaging of Transposition of the Great ArteriesRadioGraphics2021Volume: 41Issue: 2pp. 338-360Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology ArchivesRadioGraphics2018Volume: 38Issue: 1pp. 11-36Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR ImagingRadioGraphics2017Volume: 37Issue: 5pp. 1330-1351See More RSNA Education Exhibits Demystifying the Mysteries of Aorto-Atrial TunnelsDigital Posters2020A Beginner's Guide to Understanding Echocardiography with CT/MRI Correlation, Case-based Examples, and Emphasis on Blind SpotsDigital Posters2019Root Cause Analysis: Understanding Type A Aortic Dissection EquivalentsDigital Posters2020 RSNA Case Collection Stanford Type A dissectionRSNA Case Collection2020Cardiovocal SyndromeRSNA Case Collection2022Pulmonary embolism with right heart strain RSNA Case Collection2020 Vol. 3, No. 6 Metrics Altmetric Score PDF download
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