Skip to main content
SpringerLink
Log in

Sakkiforme Aneurysmen des Isthmus aortae

Differenzialdiagnose am Beispiel eines penetrierten atherosklerotischen Ulkus

Differential diagnosis of saccular aneurysms of the isthmus aortae: example of a penetrating atherosclerotic ulcer. Case-report and review of the literature

  • Kasuistiken
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Diagnostik und Therapie von Aneurysmen des Isthmus aortae sind — insbesondere nach bekanntem Thoraxtrauma — auf die Differenzialdiagnose eines akut dissezierten bzw. posttraumatischen (falschen) Aortenaneurysmas (=Aneurysma spurium) ausgerichtet. Differenzialdiagnostisch sind präoperativ penetrierte atherosklerotische Ulzera, kongenitale Aortendivertikel (Duktusdivertikel und Kommerell-Divertikel), luetische Aneurysmen und das sakkiforme Aneurysma bei Marfan-Syndrom zu berücksichtigen.

Bei einem 73 Jahre alten Patienten mit atherosklerotisch verkalktem Aortenisthmus wurde als Zufallsbefund ein 4,5 cm nach dorsal sich erstreckendes sakkiformes Aneurysma diagnostiziert. Bei der elektiven Aneurysmaresektion fand sich ein sackartiges, bis 4,5 cm durchmessendes Aneurysma mit schmaler aortaler Stilregion, so dass eine Aneurysmektomie mit Direktnaht möglich war. Nach Lokalisation und pathomorphologischen Befunden wurde die Diagnose eines penetrierten atherosklerotischen Ulkus als Ursache des subtotal thrombosierten Aneurysmas gestellt.

Das differenzialdiagnostische Spektrum thorakaler Aortenaneurysmen wie penetrierte atherosklerotische Ulzera, akut dissezierende Aneurysmen und posttraumatische (falsche) Aneurysmen, Duktusdivertikel, Kommerell-Divertikel, luetische Aneurysmen sowie sakkiforme Aneurysmen bei Marfan-Syndrom werden unter Berücksichtigung der aktuellen Literatur zusammenfassend dargestellt.

Abstract

Most aneurysms of the isthmus aortae, particularly those following thoracic trauma, are most likely to be diagnosed as acute dissecting or post-traumatic pseudoaneurysms. Furthermore, penetrating atherosclerotic ulcers in patients with atherosclerosis, congenital aneurysms such as ductus diverticulum and Kommerell’s diverticulum, luetic aneurysms, and saccular aneurysms associated with Marfan’s syndrome have to be included in the list of differential diagnoses.In view of the severe effect of any open thoracic surgical intervention, exact preoperative diagnosis is crucial. We report the case of a 73-year-old male patient who was accidentally diagnosed with an aneurysm of the atherosclerotic isthmus aortae. The aneurysm extended from the aorta to the dorsal site. The sacciform aneurysm (4.5 cm) was resected electively. Based upon localisation and pathomorphological findings, a penetrating ulcer was diagnosed. We also present a review of the current literature and give a survey of the differential diagnoses of aneurysms of the aortic isthmus: penetrating atherosclerotic ulcus, acute (traumatic) dissecting aneurysm, post-traumatic pseudoaneurysm, ductus diverticulum, Kommerell’s diverticulum, syphilitic aneurysm, and sacciform aneurysm due to Marfan’s syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a–f

Literatur

  1. Baker J, Julsrud P, Welch T (1993) Traumatic rupture of the aorta with ductus diverticulum: a case history. Angiology 44:248

    CAS  PubMed  Google Scholar 

  2. Coady MA, Rizzo JA, Hammond GL et al. (1998) Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg 27:1006

    CAS  PubMed  Google Scholar 

  3. Cohen AM, Crass JR, Thomas HA, Fisher RG, Jacobs DG (1992) CT evidence for the „osseous pinch“ mechanism of traumatic aortic injury. Am J Roentgenol 159:271

    Google Scholar 

  4. Crass JR, Cohen AM, Motta AO, Tomashefski JF Jr, Wiesen EJ (1990) A proposed new mechanism of traumatic aortic rupture: the osseous pinch. Radiology 176:645

    CAS  PubMed  Google Scholar 

  5. Eyler WR, Clark MD (1965) Dissecting aneurysms of the aorta: roentgen manifestations including a comparison with other types of aneurysms. Radiology 85:1047

    CAS  PubMed  Google Scholar 

  6. Ferrera PC, Ghaemmaghami PA (1997) Ductus diverticulum interpreted as traumatic aortic injury. Am J Emerg Med 15:371

    Article  CAS  PubMed  Google Scholar 

  7. Fishbone G, Robbins DI, Osborn DJ, Grnja V (1973) Trauma to the thoracic aorta and great vessels. Radiol Clin North Am 11:543

    CAS  PubMed  Google Scholar 

  8. Fleming AW, Green DC (1974) Traumatic aneurysms of the thoracic aorta. Report of 43 patients.Ann Thorac Surg 18:91

    CAS  PubMed  Google Scholar 

  9. Goodman PC, Jeffrey RB, Minagi H, Federle MP, Thomas AN (1982) Angiographic evaluation of the ductus diverticulum. Cardiovasc Intervent Radiol 5:1

    CAS  PubMed  Google Scholar 

  10. Grollman JH (1989) The aortic diverticulum: a remnant of the partially involuted dorsal aortic root. Cardiovasc Intervent Radiol 12:14

    CAS  PubMed  Google Scholar 

  11. Grollman JH Jr (1995) Aortic or ductus diverticulum? Am J Roentgenol 165:487

    Google Scholar 

  12. Gundry SR, Burney RE, Mackenzie JR, Jafri SZ, Shirazi K, Cho KJ (1984) Traumatic pseudoaneurysms of the thoracic aorta. Anatomic and radiologic correlations. Arch Surg 119:1055

    CAS  PubMed  Google Scholar 

  13. Harris JA, Bis KG, Glover JL, Bendick PJ, Shetty A, Brown OW (1994) Penetrating atherosclerotic ulcers of the aorta. J Vasc Surg 19:90

    CAS  PubMed  Google Scholar 

  14. Hussain S, Glover JL, Bree R, Bendick PJ (1989) Penetrating atherosclerotic ulcers of the thoracic aorta. J Vasc Surg 9:710

    Article  CAS  PubMed  Google Scholar 

  15. Jikuya T, Matsuzaki K, Watanabe K, Mitsui T (1998) Aortic dissection extending from ductus diverticulum aneurysm. Jpn J Thorac Cardiovasc Surg 46:595

    CAS  PubMed  Google Scholar 

  16. Kodolitsch von Y, Nienaber CA (1998). Das Ulkus der thorkalen Aorta: Diagnostik, Therapie und Prognose [Ulcer of the thoracic aorta: diagnosis, therapy and prognosis]. Z Kardiol 87:917

    Article  PubMed  Google Scholar 

  17. Kommerell B (1936). Verlagerung des Ösophagus durch eine abnorm verlaufende Arteria subclavia dextra (Arteria lusoria). Fortschr Geb Roentgenstrahlen 54:590

    Google Scholar 

  18. Mitchell RS, Seifert FC, Miller DC, Jamieson SW, Shumway NE (1983) Aneurysm of the diverticulum of the ductus arteriosus in the adult. Successful surgical treatment in five patients and review of the literature. J Thorac Cardiovasc Surg 86:400

    CAS  PubMed  Google Scholar 

  19. Moon MR, Sundt TM 3rd (2002). Aortic arch aneurysms. Coron Artery Dis 13:85

    Article  PubMed  Google Scholar 

  20. Morse SS, Glickman MG, Greenwood LH et al. (1988) Traumatic aortic rupture: false-positive aortographic diagnosis due to atypical ductus diverticulum. Am J Roentgenol 150:793

    CAS  Google Scholar 

  21. Mossad E, Farid I, Youssef G, Ando M (2002) Diverticulum of Kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation. Anesth Analg 94:1462

    Google Scholar 

  22. Movsowitz HD, Lampert C, Jacobs LE, Kotler MN (1994) Penetrating atherosclerotic aortic ulcers. Am Heart J 128:1210

    CAS  PubMed  Google Scholar 

  23. Orend KH, Scharrer-Pamler R, Kapfer X, Kotsis T, Gorich J, Sunder-Plassmann L (2003) Endovascular treatment in diseases of the descending thoracic aorta: 6-year results of a single center. J Vasc Surg 37:91

    Article  PubMed  Google Scholar 

  24. Sagic D, Miric M, Popovic Z, Grujicic S, Bojic M (1997) Ductus diverticulum aneurysm associated with bicuspid aortic valve and dilatation of ascending aorta. J Cardiovasc Surg (Torino) 38:137

    Google Scholar 

  25. Sailer J, Peloschek P, Rand T, Grabenwoger M, Thurnher S, Lammer J (2001) Endovascular treatment of aortic type B dissection and penetrating ulcer using commercially available stent-grafts. Am J Roentgenol 177:1365

    CAS  Google Scholar 

  26. Sanborn JC, Heitzman ER, Markarian B (1970) Traumatic rupture of the thoracic aorta. Roentgen-pathological correlations. Radiology 95:293

    CAS  PubMed  Google Scholar 

  27. Shennan T (1934) Dissecting aneurysms. Medical Research Council. Special Report Series 193

  28. van Son JA, Konstantinov IE (2002) Burckhard F. Kommerell and Kommerell’s diverticulum. Tex Heart Inst J 29:109

    Google Scholar 

  29. Vorwerk D, Klose KC, Bardos P (1987) Duktusdivertikel oder Aortenruptur: ein differentialdiagnostisches Problem beim Schwerverletzten. [Ductus arteriosus diverticulum or aortic rupture: a differential diagnostic problem in severely injured patients]. ROFO Fortschr Geb Rontgenstr Nuklearmed 147:219

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinik Bergmannsheil der Ruhr-Universität Bochum

    A. M. Müller & K.-M. Müller

  2. Klinik für Herz- und Thoraxchirurgie, Universitätsklinik Bergmannsheil der Ruhr-Universität Bochum

    J. Hoffmann & A. M. Laczkovics

  3. Institut für Radiologie und Nuklearmedizin, Universitätsklinik Bergmannsheil der Ruhr-Universität Bochum

    A. Weber

  4. Institut für Pathologie an den Berufsgenossenschaftlichen Kliniken, Bergmannsheil-Universitätsklinik, Bürkle-de-la-Camp-Platz 1, 44789 , Bochum

    A. M. Müller

Authors
  1. A. M. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. M. Laczkovics
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K.-M. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. M. Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller, A.M., Hoffmann, J., Weber, A. et al. Sakkiforme Aneurysmen des Isthmus aortae. Chirurg 75, 713–718 (2004). https://doi.org/10.1007/s00104-003-0784-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-003-0784-6

Schlüsselwörter

Keywords

Search

Navigation