1) To detail the anatomic location and clinical presentation of symptomatic aneurysms. 2) To review appropriate imaging strategies using CT angiography. 3) To emphasize physiologic support and patient monitoring while in the imaging environment. 4) To utilize appropriate anatomic coverage in CT angiography procedures for both the diagnosis of symptomatic aneurysms and surgical and endovascular planning. 5) To detail the role of 2D and 3D image processing in the emergency situation for anatomic diagnosis and treatment planning.
Symptomatic aneurysms cover the spectrum of arterial aneurysms presenting with a) localized symptoms secondary to aneurysm expansion and possible rupture b) regional symptoms secondary to dissection and embolism and c) systemic cardiovascular dysfunction related to hypotension and organ dysfunction. Common clinical scenarios include aneurysm rupture – most commonly abdominal aortic, popliteal and abdominal visceral aneurysms as well as thoracoabdominal aortic dissection. Symptomatic aneurysms may also occur in patients with known arterial pathology including connective tissue disorders such as Marfan’s and Ehlers-Danlos syndrome and Takayasu aortitis/arteritis. Patients with suspected rupture of abdominal aortic or ileofemoropopliteal artery aneurysms may initially be evaluated by sonography. However, in all circumstances, CT angiography due to its robust implementation and high-resolution imaging of the vasculature and regional anatomy that allows for planning of endovascular and surgical intervention is the preferred technique. CT Angiographic protocols appropriate to the suspected anatomic location of the aneurysm that provide an adequate roadmap for endovascular or surgical intervention are employed. Extended coverage is particularly important in patients with suspected thoracoabdominal aortic dissection or aneurysms associated with peripheral embolism. Cardiac gating should be utilized in any patient with a suspected type A aortic dissection or rupture of an ascending aortic aneurysm. Aortic, cardiac and coronary artery imaging are integral to the evaluation and management of these patients. A particular subset of the “symptomatic aneurysm” is post-trauma aortic disruption, usually thoracic in which diagnosis of traumatic aneurysm is critical and the aneurysm is associated with additional sites of soft tissue and skeletal trauma. Guidelines for endovascular or surgical intervention or non invasive management with serial CT Angiographic imaging will be discussed.
Foley, W,
Symptomatic Aneurysms. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/13012009.html
