Acute dissection of the descending aorta: noncommunicating versus communicating forms Monvadi B Srichai, MD, Michael L Lieber, MS, Bruce W Lytle, MD,

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Presentation transcript:

Acute dissection of the descending aorta: noncommunicating versus communicating forms Monvadi B Srichai, MD, Michael L Lieber, MS, Bruce W Lytle, MD, Jane M Kasper, RN, Richard D White, MD The Annals of Thoracic Surgery Volume 77, Issue 6, Pages 2012-2020 (June 2004) DOI: 10.1016/j.athoracsur.2003.08.030

Fig 1 Noncommunicating dissecting intramural hematoma beginning in the descending aorta on magnetic resonance imaging. Transaxial T1-weighted images of the aorta at the arch (left), mid-descending (center), and retrocardiac (right) segments show a crescentic to circumferential collection of relatively bright material representing intramural hematoma (arrows). The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 2 Dark-blood (left), bright-blood (center), and systolic tissue-tagged (right) oblique-sagittal magnetic resonance imaging images confirm an immobile (ie, no grid movement on tissue-tagging) intramural thrombus mass (arrows). The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 3 Noncommunicating dissecting intramural hematoma beginning in the descending aorta on computed tomography. Contrast-enhanced transaxial images at the arch (top left), proximal descending (top right), mid-descending (bottom left) and retrocardiac segment (bottom right) of the thoracic aorta demonstrate a spiraling crescentic to circumferential collection of moderately high-attenuating material within the aortic wall, representing intramural hematoma (arrows). Its attenuation was unchanged from precontrast scans owing to lack of communication with the central aortic lumen. The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 4 Flow diagram of complications and interventional needs in the noncommunicating dissecting intramural hematoma (NCDIH) group. Day number refers to the number of days after the initial onset of symptoms that the event occurred. Patients may have presented late to the treating institution leading to the delay in interventional treatment. (f/u = follow-up.) The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 5 Noncommunicating dissecting intramural hematoma patient exhibiting acute end-organ ischemia. Two original images (top left, top middle), a maximum-intensity projection (top right), and a curved-multiplanar reconstruction (bottom) of a time-resolved contrast-enhanced magnetic resonance imaging angiography series confirm occlusion of the right renal artery (arrows) by the nonenhancing thickened portion of the abdominal aorta, representing the intramural hematoma. This results in lack of a right nephrogram (circles), whereas the left kidney is perfused by a patent left renal artery. The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 6 Flow diagram of complications and interventional needs in the communicating dissection (CD) group. Day number refers to the number of days after the initial onset of symptoms that the event occurred. Patients may have presented late to the treating institution leading to the delay in interventional treatment. (f/u = follow-up.) The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)

Fig 7 Noncommunicating dissecting intramural hematoma patient exhibiting subacute dilatation with saccular outpouchings. Corresponding dark-blood (left), bright-blood (center), and maximum-intensity projection (right) oblique-sagittal images on the day of acute presentation (top) and 20 days later (bottom) demonstrate the rapid development of large saccular outpouchings (arrows) into the intramural hematoma. The Annals of Thoracic Surgery 2004 77, 2012-2020DOI: (10.1016/j.athoracsur.2003.08.030)