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主动脉急症的CT诊断;内容; AORTIC DISSECTION主动脉夹层;Classification 分类;Type A: 90% die within 3 months if not treated urgent operation
Type B: medications or interventional treatment;Chest Radiographic Findings胸片表现; Role of MDCT angiography动脉CTA作用;Unenhanced CT 平扫;Classification: Stanford type A ;Stanford type B;False lumen
Larger cross sectional area ( Pfalse ≥ Ptrue )
Delayed enhancement/ thrombosis
Beak sign;Cobweb sign
True lumen: its continuity with an undissected portion of the aorta;Complications of Thoracic AD并发症;Complications of Abdominal AD并发症;Malperfusion灌注不良;Branch Vessel Obstruction分支血管阻塞;Dynamic occlusion:动态闭塞
- true lumen resembles a C-shaped envelope that is
predominantly concave toward the false lumen
- treated with a fenestration procedure
;Static occlusion:静态闭塞
- intimal flap intersects or
enters the branch-vessel
origin
- treated locally with an
intravascular stent
;陷阱Pitfalls of MDCT;ECG-gated Vs. Non- ECG-gated ;;How to write report;INTRAMURAL HEMATOMA壁间血肿;Precontrast CT, narrow window
“Hyperattenuating crescent” on precontrast CT
No contrast enhancement, smooth margin
30% rate of progression to overt aortic dissection
;Subacute Intramural Hematoma亚急性壁间血肿;Differentiation of acute IMH from mural thrombus or thrombosed false lumen seen in AD ;AD false lumen thrombosis:
multilayered pattern of increasing attenuation
intimal flap (when you scroll up and down..)
;Natural history of IMH;Can resolve:followed 2 months.;(a) Unenhanced axial CT image obtained at presentation depicts a type B aortic intramural hematoma (arrow).
(b) Contrastenhanced axial CT image obtained 1 month later shows an enhancing ulcerlike projection (arrow), a finding suggestive of a new intimal tear.
(c) Contrastenhanced axial CT image obtained 2 months later shows overt dissection(arrow).
;Can
progress
to
fusiform
aneurysm…
可进展为梭形动脉瘤; F/70 acute chest and upper back pain;Observation acute chest pain;Differential Diagnosis鉴别诊断; F/23 pa
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