Non-traumatic thoracic aortic emergencies: imaging diagnosis and management.

Jen, Jian Ping, Malik, Akif, Lewis, Gareth and Holloway, Benjamin (2020) Non-traumatic thoracic aortic emergencies: imaging diagnosis and management. British journal of hospital medicine (London, England : 2005), 81 (10). pp. 1-12. ISSN 1750-8460.

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The major component of non-traumatic thoracic aortic emergencies is the acute aortic syndromes. These include acute aortic dissection, intramural haematoma and penetrating atherosclerotic ulcer, grouped together because they are indistinguishable clinically and highly fatal. All three entities involve disruption to the tunica intima and media and may be complicated by rupture, end-organ ischaemia or aneurysmal transformation. Early diagnosis is vital to allow timely and appropriate management. Paired unenhanced and electrocardiogram-gated computed tomography angiography of the chest, extending more distally if required, is recommended for diagnosis. Specific computed tomography features of all three entities are reviewed, with a focus on morphological features associated with complications. Those with type A pathology are usually managed with open surgery because this has a high risk of complication. Patients with uncomplicated type B pathology are usually managed with best medical therapy whereas those with complicated type B pathology are usually offered either surgery or thoracic endovascular aortic repair. The limited evidence regarding the use of thoracic endovascular aortic repair in patients with subacute uncomplicated type B pathology is briefly discussed.

Item Type: Article
Subjects: WN Medical imaging. Radiology
Divisions: Clinical Support > Radiology
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Depositing User: Mr Philip O'Reilly
Date Deposited: 11 Nov 2020 11:49
Last Modified: 11 Nov 2020 11:49

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