Diseksi Aorta. PENDAHULUAN Aorta adalah kanal yang dilalui oleh darah yang dipompakan oleh ventrikel kiri yang kemudian dihantarkan ke sirkulasi. Document covering acute and chronic aortic diseases of the thoracic . Guidelines † Aortic diseases † Aortic aneurysm † Acute aortic. Diseksi aorta klasik umumnya diawali dari robekan tunika intima dinding aorta, menyebabkan darah mengalir masuk menuju media.
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Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the mediaforming a second blood-filled channel within the wall. The majority of aortic dissections are seen in elderly hypertensive patients. In a very small minority, an underlying connective tissue disorder may be present.
Other conditions or predisposing factors may also be encountered, in which case they will be reflected in the demographics. Patients are often hypertensive although they may be normotensive or hypotensive and present with anterior or posterior chest pain and a tearing sensation in the chest.
There may be a difference in blood pressure between the two arms depending on where the dissection occurs. Some cases of aortic dissection may result in rupture, causing collapse and often death. Signs of cardiac tamponade Beck’s triad may also be encountered if rupture occurs into the pericardial space.
There have been efforts to construct a clinical decision rule stratify risk of acute aortic dissection and avoid over-investigation. The aortic dissection detection risk score Dideksi combined with a negative d-dimer test has been demonstrated to be effective in reducing unnecessary exams, however, it has not been widely accepted into clinical practice and requires further validation 13, The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen.
In xorta cases the vessel wall is abnormal. Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification which dictates management. Two classification systems are in common usage, both of which divide dissections according to the involvement of the ascending aorta:.
In recent years, the Stanford classification has gained favour with cardiothoracic surgeons. Aortic dissection are also sometimes classified as communicating versus non-communicating A new classification system was proposed which is referred with the acronym DISSECT d uration, i ntimal tear, s ize of dissected aorta, s egmental e xtent of involvement, c linical complications, and t hrombosis of the false lumen CT, especially with arterial contrast enhancement CTA is the investigation of choice, able not only to diagnose and classify the dissection but also to evaluate for distal complications.
Non-contrast CT may demonstrate only subtle findings; however, a high-density mural hematoma is often visible. Displacement of atherosclerotic calcification into the lumen is also a frequently identified finding. Dissections involving the aortic root should ideally be assessed with ECG-gated CTA which nearly totally eliminates pulsation artefact. An essential part of the assessment of aortic dissection is identifying the true lumen, as the placement of an endoluminal stent graft in the false lumen can have dire consequences.
Distinguishing between the two is often straightforward, but in some instances, no clear continuation of one lumen with normal artery can be identified. In such instances, a number of features are helpful Chronic dissection flaps are often thicker and straighter than those seen in acute dissections 3.
Transoesophageal echocardiography TOE has very high sensitivity and specificity for assessment of acute aortic dissection, but due to limited access and its invasive nature, it has largely been replaced by CTA or MRA in some instances 5. Although in general MRA has been reserved for follow-up examinations, rapid non-contrast imaging techniques e. It has similar sensitivity and specificity to CTA and TOE 5 but suffers from limited availability and the difficulties inherent in performing MRI on acutely unwell patients.
Aortic dissection | Radiology Reference Article |
Conventional digital subtraction angiography has historically been the gold standard investigation. CTA has now replaced it as the first line investigation, not only due to it being non-invasive but also on account of better delineation of the poorly opacifying aogta lumen, intramural hematoma and end-organ ischemia.
Risks of angiography include general risks of angiography plus the risk of catheterising the false lumen and causing aortic rupture. The differential on chest x-ray is that of a dilated thoracic aorta. To quiz yourself on this article, log in to see multiple choice questions.
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Edit article Share article View revision history. CardiacVascularChest. Synonyms or Alternate Spellings: Dissection of the thoracic aorta Dissection of the aorta Dissection of aorta.
Support Radiopaedia and see fewer ads. Disesi type A Case 1: Stanford type B Case 3: Stanford type B Case 4: Stanford type B Case 5: Stanford type A with rupture into pericardium Case 7: Stanford type A with rupture into pericardium. Stanford type B dissecting aneurysm Case Stanford type B dissecting aneurysm.
Stanford type A Case Case 17 Case Stanford type B Case Loading Stack – 0 images remaining.