Pseudo-aneurysm of Descending Aorta Presenting as Incarcerated Intrathoracic Stomach
Wickii T. Vigneswaran in Thoracic Surgery, 2019
Paraesophageal hernias cause few or no symptoms and remain undiagnosed for years until they are recognized on imaging or symptoms resulting from mechanical consequences of an intrathoracic stomach. The potential complications include bleeding, incarceration, perforation and strangulation. The common symptoms are due to obstruction, such as post prandial pain, vomiting and dysphagia. Similarly an aortic aneurysm can remain asymptomatic for years, remaining undiagnosed until it’s incidentally found on imaging, or until it ruptures and triggers symptoms. Both conditions most often affect the elderly, a group who regularly harbor additional comorbidities. Therefore, diagnosis and management of these two rare and potentially lethal conditions is challenging, often requiring advanced skills.
Prognosis: Studies of disease course and outcomes
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
Making a prognosis based simply on knowing how many patients will survive a certain time period (e.g. five years following the detection of a cancer or any other disease) would rely on very poor information since the exact timing (moment of occurrence) of the events in this five-year period would be ignored. As shown by Fletcher et al.,11 several diseases may show a comparable survival rate at a given moment, 10% for example. Such a prognosis can be made for a rapidly dissecting aortic aneurysm: Subjects mainly die within the first one or two years following its discovery. A similar five-year survival rate can be observed in chronic granulocytic leukemia, but more patients survive beyond the first year and years after within the same five-year period. Similarly, Figure 10.4 represents two survival curves for glioma patients.27
Predicting the Biomechanics of the Aorta Using Ultrasound
Ayman El-Baz, Jasjit S. Suri in Cardiovascular Imaging and Image Analysis, 2018
Thoracic aortic disease continues to be associated with a significant burden of morbidity and mortality in the general population. Disease of the thoracic aorta is due to aneurysm and/or dissection. An aneurysm is by definition an aortic diameter twice the normal size. This can lead to frank rupture or dissection then rupture. A dissection is a tearing of the inner lumen of the aorta such that the layers of the media separate and blood flows into a false lumen as well as the true lumen. An aortic rupture and an ascending aortic dissection (Type A) are considered surgical emergencies. The mortality is high and generally over 50% are dead without surgical treatment within two weeks. Despite improvement in diagnostics and advanced surgical techniques, mortality rates following surgery for acute aortic syndromes such as a rupture or type A aortic dissection continue to be associated with an overall mortality of 20–25% and significant morbidity such as stroke [1–5]. This high mortality following acute life-saving surgery is contrasted by the much lower risk of mortality (1.5–2.5%) when the ascending aortic aneurysm is repaired electively [3, 4, 6, 7]. This comparison illustrates the critical importance of early detection of individuals at risk for acute aortic syndromes such as dissection and rupture. Currently, most aortic aneurysms are detected incidentally when undergoing imaging for an unrelated issue, as aortic disease is generally asymptomatic until a first presentation of catastrophic dissection or even sudden death [9].
CFD analysis of the hyper-viscous effects on blood flow across abdominal aortic aneurysm in COVID patients: multiphysics approach
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Shankar Narayan S., Anuradha Bhattacharjee, Sunanda Saha
The human aorta contains three layers: the inner layer (intima), the middle layer (media), and the outer layer, which can be more than an inch broad in certain locations (adventitia). The aorta can develop issues that endanger the heart and the blood flow to the rest of the body (Witmer 2008; Oomens et al. 2017; Gasser 2017). An aortic aneurysm is a weak spot or bulge on the aorta’s wall that can develop anywhere along the vessel’s length. Two issues can result from aortic aneurysms. A hole, known as a rupture, might form in the weaker or inflated region, allowing blood to leak into the body. The layers of the artery wall can be separated by the blood that is forced through the aorta, enabling blood to accumulate there and further dividing the arterial wall. Aortic dissections occur when the layers of the aorta, which carry blood from the heart, separate. This may result in aortic rupture or reduced blood supply to organs (ischemia).
Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method
Published in Acta Cardiologica, 2022
Adem Adar, Orhan Onalan, Fahri Cakan, Hakan Keles, Ertan Akbay, Sinan Akıncı, Ali Coner, Cevahir Haberal, Haldun Muderrisoglu
Untreated and unmonitored aortic aneurysm may result in aortic dissection leading to mortality. The aetiology of aortic dilatation is multifactorial such as hypertension, infections, genetic factors, Marfan syndrome, bicuspid aortic valve, Ehler-danlos syndrome and idiopathic conditions [14]. In this context, PAT, as a paracrine organ, also may play an important role in the aetiology of aortic dilatation through the cytokines it secretes [15], which has been reported to result in more aortic function, width, and atherosclerosis [16,17]. PAT measurement can be used safely in the follow-up of aortic dilatation [18]. Various studies in the literature have discussed the measurement of PAT using CT and MRI. PAT measurement has not received the attention it deserves in clinical practice since measurements are predominately performed using CT and MRI, which are commonly requested for other indications, However, such methods require the use of special software and requires expensive equipment and time to perform. Conversely, TTE is available in almost every healthcare facility around the globe. We found that PAT measured using TTE is an important predictor of ascending aortic width.
Incidence and predictors of thoracic aortic damage in biopsy-proven giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2021
MJ Koster, CS Crowson, C Labarca, KJ Warrington
This study reports the findings from a large, single-institution cohort of patients with biopsy-proven GCA with aortic imaging. Prevalent aortic aneurysm/dilatation was observed in 8% of patients on the first imaging study. Although several investigations have focused on the presence of baseline aortitis and subsequent aortic aneurysm/dilatation, few studies report the frequency of thoracic aorta aneurysm/dilatation at, or near, diagnosis; thus, estimates of prevalent AoSD are not well established. In a retrospective analysis of 52 patients who had undergone at least two positron emission tomography–computed tomography (PET-CT) scans performed after GCA diagnosis, Muratore et al demonstrated that 21.2% of patients had aortic dilatation at the time of the first imaging study (12). In a prospective cohort, Agard and colleagues noted a frequency of thoracic aortic aneurysm in 14% and thoracic aortic aneurysm/ectasia in 23% of 22 biopsy-proven GCA patients undergoing helical CT performed within 4 weeks of diagnosis (13). Although prevalent aneurysm rates in the current study are lower than in these previous studies, our results are similar to the large retrospective study by de Boysson and colleagues, where 398 GCA patients underwent baseline arterial imaging and 8.5% (n = 34) had prevalent aortic dilatation (6). Given the notable frequency of baseline aortic disease, it is considered reasonable to obtain routine thoracic aortic imaging at the time of GCA diagnosis, as suggested by American thoracic consensus guidelines (9).
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