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Imaging of Nontraumatic Vascular Emergencies

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Atlas of Emergency Imaging from Head-to-Toe

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Abstract

Nontraumatic emergencies involving the abdominal vasculature are common and associated with significant morbidity and mortality. These conditions are almost always diagnosed or confirmed using cross-sectional imaging, and thus the radiologist plays an essential role in guiding appropriate patient management. Computed tomography (CT) angiography is the workhorse modality for evaluating patients with suspected acute vascular pathology, but magnetic resonance angiography (MRA) may be appropriate in carefully selected patients. Abdominal aortic aneurysms (AAAs) are frequently encountered in practice; however, findings of aneurysm instability or rupture may be subtle but are critically important to identify. Following open AAA repair, complications may include anastomotic pseudoaneurysm, aortoenteric and aortopancreatic fistula, graft infection, and thrombosis. After endovascular AAA repair, important complications include endoleak, rupture, stent kinking, thrombosis, and infection. Aortitis and periaortitis can occur due to a broad variety of causes. Of these, infectious aortitis is most concerning, as it can progress rapidly to infectious pseudoaneurysm and rupture. Acute aortic occlusion, while uncommon, is associated with high morbidity and mortality. Acute pathology affecting the medium-sized abdominal vessels includes vasculitis, segmental arterial mediolysis (SAM), pseudoaneurysm, and embolic or thrombotic occlusion. Complications of medium-vessel pathology present acutely and commonly include hemorrhage and visceral ischemia. The objective of this chapter is to review and illustrate the most important nontraumatic abdominal vascular emergencies and their associated complications.

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References

  1. Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.

    Article  PubMed  Google Scholar 

  2. Laissy JP, Trillaud H, Douek P. MR angiography: noninvasive vascular imaging of the abdomen. Abdom Imaging. 2002;27(5):488–506.

    Article  CAS  PubMed  Google Scholar 

  3. Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101–8.

    Article  CAS  PubMed  Google Scholar 

  4. Newman JD, Motiwala A, Turin A, Chen A, Maharaj VR, Dieter RS. Abdominal aortic aneurysms. In: Diseases of the aorta. Springer; 2019. p. 199–216.

    Chapter  Google Scholar 

  5. Parkinson F, Ferguson S, Lewis P, Williams IM, Twine CP. South East Wales Vascular Network. Rupture rates of untreated large abdominal aortic aneurysms in patients unfit for elective repair. J Vasc Surg. 2015;61(6):1606–12.

    Article  PubMed  Google Scholar 

  6. Wadgaonkar AD, Black JH, Weihe EK, Zimmerman SL, Fishman EK, Johnson PT. Abdominal aortic aneurysms revisited: MDCT with multiplanar reconstructions for identifying indicators of instability in the pre- and postoperative patient. Radiographics. 2015 Feb;35(1):254–68.

    Article  PubMed  Google Scholar 

  7. Curtis W, Yano M. Acute non-traumatic disease of the abdominal aorta. Abdom Radiol (NY). 2018;43(5):1067–83.

    Article  Google Scholar 

  8. Siegel CL, Cohan RH, Korobkin M, Alpern MB, Courneya DL, Leder RA. Abdominal aortic aneurysm morphology: CT features in patients with ruptured and nonruptured aneurysms. AJR Am J Roentgenol. 1994;163(5):1123–9.

    Article  CAS  PubMed  Google Scholar 

  9. Arita T, Matsunaga N, Takano K, Nagaoka S, Nakamura H, Katayama S, et al. Abdominal aortic aneurysm: rupture associated with the high-attenuating crescent sign. Radiology. 1997;204(3):765–8.

    Article  CAS  PubMed  Google Scholar 

  10. Torres W, Maurer D, Steinberg H, Robbins S, Bernardino M. CT of aortic aneurysms: the distinction between mural and thrombus calcification. Am J Roentgenol. 1988;150(6):1317–9.

    Article  CAS  Google Scholar 

  11. Pillari G, Chang JB, Zito J, Cohen JR, Gersten K, Rizzo A, et al. Computed tomography of abdominal aortic aneurysm: an in vivo pathological report with a note on dynamic predictors. Arch Surg. 1988;123(6):727–32.

    Article  CAS  PubMed  Google Scholar 

  12. Hunter GC, Leong SC, Yu GS, McIntyre KE, Bernhard VM. Aortic blebs: possible site of aneurysm rupture. J Vasc Surg. 1989;10(1):93–9.

    Article  CAS  PubMed  Google Scholar 

  13. Vu K-N, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux M-F, Thérasse É, et al. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging. 2014;5(3):281–93.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Halliday KE, al-Kutoubi A. Draped aorta: CT sign of contained leak of aortic aneurysms. Radiology. 1996;199(1):41–3.

    Article  CAS  PubMed  Google Scholar 

  15. Apter S, Rimon U, Konen E, Erlich Z, Guranda L, Amitai M, et al. Sealed rupture of abdominal aortic aneurysms: CT features in 6 patients and a review of the literature. Abdom Imaging. 2010;35(1):99–105.

    Article  CAS  PubMed  Google Scholar 

  16. Badger S, Forster R, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2017;26. 5:CD005261

    Google Scholar 

  17. Powell AR, Crowl G, Kashyap VS. Surgical treatment of the abdominal aorta. In: Diseases of the aorta. Springer; 2019. p. 293–306.

    Chapter  Google Scholar 

  18. van Zeeland ML, van der Laan L. Late complications following aortic aneurysm repair. Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms; 2011. p. 211.

    Google Scholar 

  19. Tsai R, Sanchez LA, Yano M. Computed tomography identifies clinically unsuspected acute necrotizing pancreatitis complicating abdominal aortic repair. Ann Vasc Surg. 2020.

    Google Scholar 

  20. Buck DB, van Herwaarden JA, Schermerhorn ML, Moll FL. Endovascular treatment of abdominal aortic aneurysms. Nat Rev Cardiol. 2014;11(2):112–23.

    Article  PubMed  Google Scholar 

  21. Liaw JVP, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: complications and management of infrarenal EVAR. Eur J Radiol. 2009;71(3):541–51.

    Article  CAS  PubMed  Google Scholar 

  22. Fransen GAJ, Desgranges P, Laheij RJF, Harris PL, Becquemin J-P, EUROSTAR Collaborators. Frequency, predictive factors, and consequences of stent-graft kink following endovascular AAA repair. J Endovasc Ther. 2003;10(5):913–8.

    Article  PubMed  Google Scholar 

  23. Maleux G, Koolen M, Heye S. Complications after endovascular aneurysm repair. Semin Intervent Radiol. 2009;26(1):3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hobbs SD, Kumar S, Gilling-Smith GL. Epidemiology and diagnosis of endograft infection. J Cardiovasc Surg. 2010;51(1):5.

    CAS  Google Scholar 

  25. Laser A, Baker N, Rectenwald J, Eliason JL, Criado-Pallares E, Upchurch GR. Graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2011;54(1):58–63.

    Article  PubMed  Google Scholar 

  26. Restrepo CS, Ocazionez D, Suri R, Vargas D. Aortitis: imaging spectrum of the infectious and inflammatory conditions of the aorta. RadioGraphics. 2011;31(2):435–51.

    Article  PubMed  Google Scholar 

  27. Mendelowitz DS, Ramstedt R, Yao JS, Bergan JJ. Abdominal aortic salmonellosis. Surgery. 1979;85(5):514–9.

    CAS  PubMed  Google Scholar 

  28. Sekar N. Primary aortic infections and infected aneurysms. Ann Vasc Dis. 2010;3(1):24–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Macedo TA, Stanson AW, Oderich GS, Johnson CM, Panneton JM, Tie ML. Infected aortic aneurysms: imaging findings. Radiology. 2004;231(1):250–7.

    Article  PubMed  Google Scholar 

  30. Kim J, Song H-C. Role of PET/CT in the evaluation of aortic disease. Chonnam Med J. 2018;54(3):143–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, et al. Immunoglobulin G4–related periaortitis and periarteritis: CT findings in 17 patients. Radiology. 2011;261(2):625–33.

    Article  PubMed  Google Scholar 

  32. Lian L, Wang C, Tian J-L. IgG4-related retroperitoneal fibrosis: a newly characterized disease. Int J Rheum Dis. 2016;19(11):1049–55.

    Article  CAS  PubMed  Google Scholar 

  33. Kasashima S, Zen Y. IgG4-related inflammatory abdominal aortic aneurysm, spectrum of IgG4-related chronic periaortitis. Ann Vasc Dis. 2010;3(3):182–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Corvera JS. Acute aortic syndrome. Ann Cardiothorac Surg. 2016;5(3):188–93.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nathan DP, Boonn W, Lai E, Wang GJ, Desai N, Woo EY, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012 Jan;55(1):10–5.

    Article  PubMed  Google Scholar 

  36. Bonaca MP. Descending aortic dissection, penetrating aortic ulcer, and intramural hematoma (acute and chronic) including Kommerell’s diverticulum. In: Diseases of the aorta. Springer; 2019. p. 149–60.

    Chapter  Google Scholar 

  37. Chao CP, Walker TG, Kalva SP. Natural history and CT appearances of aortic intramural hematoma. Radiographics. 2009 Jun;29(3):791–804.

    Article  PubMed  Google Scholar 

  38. Moral S, Cuéllar H, Avegliano G, Ballesteros E, Salcedo MT, Ferreira-González I, et al. Clinical implications of focal intimal disruption in patients with type b intramural hematoma. J Am Coll Cardiol. 2017;69(1):28–39.

    Article  PubMed  Google Scholar 

  39. McMahon MA, Squirrell CA. Multidetector CT of aortic dissection: a pictorial review. RadioGraphics. 2010;30(2):445–60.

    Article  PubMed  Google Scholar 

  40. LePage MA, Quint LE, Sonnad SS, Deeb GM, Williams DM. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol. 2001;177(1):207–11.

    Article  CAS  PubMed  Google Scholar 

  41. Meinel FG, Nikolaou K, Weidenhagen R, Hellbach K, Helck A, Bamberg F, et al. Time-resolved CT angiography in aortic dissection. Eur J Radiol. 2012;81(11):3254–61.

    Article  PubMed  Google Scholar 

  42. Olivia G, Anders W, Martin B. Acute aortic occlusion. Circulation. 2019;139(2):292–4.

    Article  Google Scholar 

  43. Robinson WP, Patel RK, Columbo JA, Flahive J, Aiello FA, Baril DT, et al. Contemporary management of acute aortic occlusion has evolved but outcomes have not significantly improved. Ann Vasc Surg. 2016;34:178–86.

    Article  PubMed  Google Scholar 

  44. Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, et al. CT features of vasculitides based on the 2012 international Chapel Hill consensus conference revised classification. Korean J Radiol. 2017;18(5):786–98.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Forbess L, Bannykh S. Polyarteritis nodosa. Rheum Dis Clin N Am. 2015;41(1):33–46. vii

    Article  Google Scholar 

  46. Naidu SG, Menias CO, Oklu R, Hines RS, Alhalabi K, Makar G, et al. Segmental arterial mediolysis: abdominal imaging of and disease course in 111 patients. Am J Roentgenol. 2018;210(4):899–905.

    Article  Google Scholar 

  47. Slavin RE. Segmental arterial mediolysis: course, sequelae, prognosis, and pathologic-radiologic correlation. Cardiovasc Pathol. 2009;18(6):352–60.

    Article  PubMed  Google Scholar 

  48. Baker-LePain JC, Stone DH, Mattis A, Nakamura MC, Fye KH. Clinical diagnosis of segmental arterial mediolysis: differentiation from vasculitis and other mimics. Arthritis Care Res (Hoboken). 2010;62(11):1655–60.

    Article  Google Scholar 

  49. Lee W-K, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK, et al. Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics. 2008;28(7):1853–68.

    Article  PubMed  Google Scholar 

  50. Shih M-CP, Hagspiel KD. CTA and MRA in mesenteric ischemia: Part 1, Role in diagnosis and differential diagnosis. Am J Roentgenol. 2007;188(2):452–61.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Daniel R. Ludwig

  2. Mayo Clinic Department of Radiology, Scottsdale, AZ, USA

    Motoyo Yano

Authors
  1. Daniel R. Ludwig
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  2. Motoyo Yano
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Correspondence to Motoyo Yano .

Editor information

Editors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Michael N. Patlas

  2. NYU Langone Hospital - Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA

    Douglas S. Katz

  3. Department of Medical, Surgical and Experimental Sciences, University of Medicine and Surgery, Sassari, Italy

    Mariano Scaglione

Section Editor information

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA

    Vincent Mellnick

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Ludwig, D.R., Yano, M. (2022). Imaging of Nontraumatic Vascular Emergencies. In: Patlas, M.N., Katz, D.S., Scaglione, M. (eds) Atlas of Emergency Imaging from Head-to-Toe. Springer, Cham. https://doi.org/10.1007/978-3-030-92111-8_32

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  • DOI: https://doi.org/10.1007/978-3-030-92111-8_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-92110-1

  • Online ISBN: 978-3-030-92111-8

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