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MDCT distinguishing features of focal aortic projections (FAP) in acute clinical settings

  • EMERGENCY RADIOLOGY
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Abstract

Focal aortic projections (FAP) are protrusion images of the contrast medium (focal contour irregularity, breaks in the intimal contour, outward lumen bulging or localized blood-filled outpouching) projecting beyond the aortic lumen in the aortic wall and are commonly seen on multidetector computed tomography (MDCT) scans of the chest and abdomen. FAP include several common and uncommon etiologies, which can be demonstrated both in the native aorta, mainly in acute aortic syndromes, and in the post-surgical aorta or after endovascular therapy. They are also found in some types of post-traumatic injuries and in impending rupture of the aneurysms. The expanding, routine use of millimetric or submillimetric collimation of current state-of-the-art MDCT scanners (16 rows and higher) all the time allows the identification and characterization of these small ulcer-like lesions or irregularities in the entire aorta, as either an incidental or expected finding, and provides detailed three-dimensional pictures of these pathologic findings. In this pictorial review, we illustrate the possible significance of FAP and the discriminating MDCT features that help to distinguish among different types of aortic protrusions and their possible evolution. Awareness of some related and distinctive radiologic features in FAP may improve our understanding of aortic diseases, provide further insight into the pathophysiology and natural history, and guide the appropriate management of these lesions.

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Abbreviations

FAP:

Focal aortic projections

TEVAR:

Thoracic endovascular aortic repair

EVAR:

Endovascular aortic repair

CM:

Contrast medium

MPR:

Multiplanar reconstruction

MIP:

Maximum intensity projection

VR:

Volume rendering

AD:

Aortic dissection

AAS:

Acute aortic syndrome

IMH:

Intramural hematoma

PAU:

Penetrating atherosclerotic ulcer

ULPs:

Ulcer-like projections

IBP:

Intramural blood pool

BAP:

Branch arteries pseudoaneurysm

AA:

Aortic aneurysm

ILT:

Intraluminal thrombus

PSA:

Pseudoaneurysm

MAI:

Minimal aortic injury

BAI:

Blunt aortic injury

CPB:

Cardiopulmonary bypass

PTFE:

Polytetrafluoroethylene

EL:

Endoleak

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The authors declare that they have no conflict of interest to the publication of this article.

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Authors and Affiliations

  1. Section of General Radiology, Department of Diagnostic Imaging, Azienda Ospedali dei Colli, P.O. Monaldi, 80131, Naples, Italy

    Tullio Valente, Giovanni Rossi, Francesco Lassandro, Gaetano Rea, Maurizio Marino, Salvatore Urciuolo, Giovanni Tortora & Maurizio Muto

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  1. Tullio Valente
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  2. Giovanni Rossi
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Valente, T., Rossi, G., Lassandro, F. et al. MDCT distinguishing features of focal aortic projections (FAP) in acute clinical settings. Radiol med 120, 50–72 (2015). https://doi.org/10.1007/s11547-014-0459-z

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