Understanding the histology of the aorta and the three primary layers is crucial in chest CT angiography for acute aortic pathologic conditions.
Differentiating between aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and other acute aortic diseases can be challenging but is essential for accurate diagnosis.
Deep dives
Understanding Aortic Pathology and Classification
This podcast episode provides an overview of chest CT and geography for acute aortic pathologic conditions. The episode emphasizes the importance of understanding the histology of the aorta and the three primary layers: intima, media, and adventitia. It also discusses the Stanford classification for aortic dissection, highlighting the differences between type A and type B dissections. Additionally, the episode explores the logistics of CT angiogram acquisitions, including the use of non-contrast imaging and contrast-enhanced scans with various triggering methods.
Acute Aortic Diseases and Pitfalls in Evaluation
The podcast delves into the different acute aortic diseases, including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, limited intramural tear, and endograft rupture. It describes the classification systems for aortic dissections, such as the Stanford and DeBakey criteria. The episode discusses the challenges in differentiating penetrating atherosclerotic ulcer from ulcerative plaque and provides insights into the features of intramural hematoma. Furthermore, it highlights the pitfalls in evaluating wall thickening, such as differentiating myrotherombus from intramural hematoma and distinguishing vasculitis from aortic dissection.
Post-Surgical Aorta and Techniques
The final part of the podcast focuses on the post-surgical aorta and the techniques used for repairing the aorta, particularly the ascending aorta. It compares the interposition graft technique, which is more commonly used today, with the outdated inclusion graft technique. The episode also mentions the importance of acquiring non-contrast studies in the post-surgical state to differentiate surgical changes from potential complications like pseudoaneurysms or leaks. Additionally, it briefly discusses the use of pledges and their significance in radiopaque evaluations post-surgery.
Elliott Kirk Gozansky, MD, PhD from New York University Langone Health and Grossman School of Medicine summarizes his chest imaging article published in the RadioGraphics journal.