Clinical Significance of Intraluminal Atheroma in Patients With Ascending and Arch Aneurysm Jihang Kim, MD, Sang Il Choi, MD, Kay-Hyun Park, MD, Eun.

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Clinical Significance of Intraluminal Atheroma in Patients With Ascending and Arch Aneurysm Jihang Kim, MD, Sang Il Choi, MD, Kay-Hyun Park, MD, Eun Ju Chun, MD, Cheong Lim, MD The Annals of Thoracic Surgery Volume 97, Issue 6, Pages 2034-2040 (June 2014) DOI: 10.1016/j.athoracsur.2014.03.011 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Patient flow chart. (CT = computed tomography.) The Annals of Thoracic Surgery 2014 97, 2034-2040DOI: (10.1016/j.athoracsur.2014.03.011) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Measurement of maximal aortic diameter. (A) Volume-rendering reconstruction of the ascending aorta and the aortic arch was used to orient the centerline axis of the ascending and arch aneurysm. (B) Aortic planimetry was used to determine the largest portion of the aneurysm. (C) The maximal aortic diameter was measured in the largest diameter at a perpendicular plane to the aortic wall. The Annals of Thoracic Surgery 2014 97, 2034-2040DOI: (10.1016/j.athoracsur.2014.03.011) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Maximal plaque thickness was determined by measuring the deepest portion of the atheroma at the perpendicular plane to the aortic wall (arrow). (B) Plaque density was determined by measuring the average Hounsfield units of the plaque after locating the region of interest in the center of atheroma (dashed circle). The Annals of Thoracic Surgery 2014 97, 2034-2040DOI: (10.1016/j.athoracsur.2014.03.011) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Computed tomography performed in a 70-year-old male patient with chest pain revealed complex atheroma with ulcerated and hypoattenuating plaque, measuring greater than 4 mm in maximal thickness in the ascending aorta. (B) Forty-two months later, diffusion-weighted image showed multiple embolic infarctions in the brain. The Annals of Thoracic Surgery 2014 97, 2034-2040DOI: (10.1016/j.athoracsur.2014.03.011) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions