To-and-Fro Flow Equivalent at Dynamic CT Angiography of the Aorta
2024; Radiological Society of North America; Volume: 6; Issue: 4 Linguagem: Inglês
10.1148/ryct.240062
ISSN2638-6135
AutoresAndré Vaz, Kevin Rafael De Paula Morales, Eduardo Kaiser Ururahy Nunes Fonseca,
Tópico(s)Aortic Disease and Treatment Approaches
ResumoHomeRadiology: Cardiothoracic ImagingVol. 6, No. 4 Next Images in Cardiothoracic ImagingFree AccessTo-and-Fro Flow Equivalent at Dynamic CT Angiography of the AortaAndré Vaz , Kevin Rafael De Paula Morales, Eduardo Kaiser Ururahy Nunes FonsecaAndré Vaz , Kevin Rafael De Paula Morales, Eduardo Kaiser Ururahy Nunes FonsecaAuthor AffiliationsFrom the Departments of Cardiology (A.V., K.R.D.P.M.) and Radiology (E.K.U.N.F.), InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, Cerqueira César, São Paulo, SP 05403-900, Brazil.Address correspondence to A.V. (email: [email protected]).André Vaz Kevin Rafael De Paula MoralesEduardo Kaiser Ururahy Nunes FonsecaPublished Online:Aug 1 2024https://doi.org/10.1148/ryct.240062MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Supplemental material is available for this article. A 64-year-old male individual with a history of coronary artery bypass grafting presented with chest pain. CT angiographic images of the aorta showed a large mediastinal pseudoaneurysm with a neck in the aortic arch near the origin of the brachiocephalic trunk. Images through the cardiac cycle showed a hyperdense jet of flow originating from the pseudoaneurysmal neck and directed toward the sac during systole (Fig 1A and 1C) and a hypodense jet of flow from the neck to the aorta during diastole (Fig 1B and 1D, Movies 1 and 2), indicative of a to-and-fro waveform. Venous phase images showed homogenization of the pseudoaneurysmal sac. Intraoperative echocardiography helped confirm the diagnosis (Fig 1E and 1F, Movie 3), and the patient underwent successful surgical correction (Movie 4).A 64-year-old male individual with a history of coronary artery bypass grafting who presented with chest pain. (A, B) Axial oblique and (C, D) sagittal oblique contrast-enhanced electrocardiogram-gated CT images and (E, F) intraoperative echocardiograms depict a large pseudoaneurysmal sac in the superior and anterior mediastinum. Systolic (A, C, E) and diastolic (B, D, F) flow jets are identified from the pseudoaneurysmal neck near the previous cardiopulmonary bypass cannulation site.Download as PowerPoint Movie 1: Dynamic frontal plane volumetric imaging of the upper thorax shows the pseudoaneurysmal neck in the proximal aortic arch with jet flow directed toward the sac.Download Original Video (2.7 MB) Movie 2: Dynamic imaging of a sagittal oblique plane of the proximal aortic arch shows the pseudoaneurysmal sac and neck at the level of the brachiocephalic trunk. The jet directed toward the sac is observed in systole (the "to" flow), and the jet directed toward the lumen is observed in diastole (the "fro" flow).Download Original Video (4.4 MB) Movie 3: Intraoperative echocardiographic cine clip shows the pseudoaneurysmal sac and flow jets through the neck.Download Original Video (44.1 MB) Movie 4: Operative images during low-flow cardiopulmonary bypass show drainage of the pseudoaneurysm sac and occlusion of its neck.Download Original Video (159.2 MB) The to-and-fro flow corresponds to the waveform identified with Doppler US in the neck of pseudoaneurysms (1). The "to" corresponds to the flow directed to the sac during systole and the "fro" represents the flow from the sac to the vessel lumen during diastole (1). Advances in temporal resolution have provided advanced opportunities to characterize flow behavior in different phases of the cardiac cycle using cross-sectional study methods (2,3).Disclosures of conflicts of interest: A.V. No relevant relationships. K.R.D.P.M. No relevant relationships. E.K.U.N.F. No relevant relationships. Keywords: CT Angiography, Vascular, Aorta, Mediastinum Authors declared no funding for this work.References1. Mahmoud MZ, Al-Saadi M, Abuderman A, et al. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol 2015;7(5):89–99. MedlineGoogle Scholar2. Kim B, Kang JW, Lee CW, Chul Suh D, Lee JW, Lim TH. Pulsatile to-and-fro flow detected by contrast-enhanced electrocardiogram-gated computed tomography: a novel method for detecting the leakage point of a pseudoaneurysm. Circulation 2010;122(13):e468–e470. MedlineGoogle Scholar3. Collier P, Phelan D, Soltesz E, Aljaroudi W. Left ventricular pseudoaneurysm: "to-and-fro" flow. J Am Coll Cardiol 2013;61(8):896. MedlineGoogle ScholarArticle HistoryReceived: Feb 16 2024Revision requested: Mar 27 2024Revision received: July 10 2024Accepted: July 15 2024Published online: Aug 01 2024 FiguresReferencesRelatedDetailsRecommended Articles Mimics of Complications in the Postsurgical Aorta at CTRadiology: Cardiothoracic Imaging2019Volume: 1Issue: 4Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and PitfallsRadioGraphics2021Volume: 41Issue: 2pp. 399-424Imaging Features of Complications after Coronary Interventions and Surgical ProceduresRadioGraphics2021Volume: 41Issue: 3pp. 699-719Aortic Dissection and Other Acute Aortic Syndromes: Diagnostic Imaging Findings from Acute to Chronic Longitudinal ProgressionRadioGraphics2021Volume: 41Issue: 2pp. 425-446CT of Postoperative Repair of the Ascending Aorta and Aortic ArchRadioGraphics2021Volume: 41Issue: 5pp. 1300-1320See More RSNA Education Exhibits Postoperative Imaging of Aorta: What Need to KnowDigital Posters2020Non-Ordinary Cases of Acute Aortic Syndromes: Do Not Miss Them Out!Digital Posters2020More Than Marfan: Understanding The Imaging, Presentation And Complications Of Aortopathies Digital Posters2021 RSNA Case Collection Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)RSNA Case Collection2020Aortopulmonary fistula due to aortic dissection RSNA Case Collection2020Stanford Type A dissectionRSNA Case Collection2020 Vol. 6, No. 4 Metrics Altmetric Score PDF download
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