The report describes a previously healthy 24-year-old women presenting with acute abdominal pain following a hyperextension manoeuvre. The key finding of a continuous bruit with systolic and diastolic components in the epigastric region subsequently led to the diagnosis of an intramural haematoma of the coeliac artery, that caused a subtotal occlusion of the artery. The diagnosis was achieved by both colour-coded duplex sonography and magnetic resonance angiography. The case shows that a conservative management rather than operative reconstruction is justified in an oligo-symptomatic situation with no signs of end-organ damage as in this patient.
Penetrating aortic ulcer is a disease of the intima produced by an ulceration of atherosclerotic plaque penetrating to the media of the aortic wall. Although diagnosis can be made by all imaging techniques, computed tomography is the most useful technique due to its high spatial resolution and large field of view. Natural evolution is completely different if penetrating aortic ulcer is diagnosed in the contest of an acute aortic syndrome or incidentally. The presence of pain, rapid enlargement of the ulcer size, and intramural haematoma have been considered predictors of serious complications. In these cases, open surgery or endovascular treatment should be indicated to prevent aortic rupture. In stable and asymptomatic cases, control of blood pressure and close follow-up by imaging techniques is recommended.
Aortic dissection, intramural haematoma, and penetrating aortic ulcer can each present as an acute aortic syndrome. If left untreated, acute aortic syndrome carries a high mortality. Therefore, rapid diagnostic work-up and appropriate surgical therapy are of utmost importance. Chest computed tomography is the imaging method of first choice.
The first section of Chapter 12 details an approach to a systematic examination of the aortic root and thoracic aorta. The limitations (due to interposition of the large airways) and artefacts encountered when assessing the thoracic aorta are discussed. Normal aortic dimensions are listed in tabular format. The remainder of the chapter is concerned with the pathologies affecting the thoracic aorta, namely: aortic atheroma, aortic aneurysm, acute aortic syndromes (dissection, intramural haematoma, and penetrating ulcer), and traumatic aortic injury. Where relevant, reference to appropriate guidelines and surgical techniques are made.
This chapter covers the chambers and vessels in transoesophageal echocardiography. It includes the left and right ventricles (size, mass, and function); the left and right atria, including the left atrial appendage; the pulmonary veins; the coronary sinus; the interatrial and interventricular septa; the pericardium and pericardial effusion; cardiac tamponade; the aorta (size, atherosclerosis, and dissection); intramural haematoma; aortic transection; thoracic aortic aneurysm; masses; pleural space and lungs; and implanted devices.
Spontaneous intramural rupture and intramural haematoma of the oesophagus.