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Year : 2003  |  Volume : 13  |  Issue : 2  |  Page : 147-149
"Aortic dissection-contrast enhanced 3D MR angiography - a case report"


Department of Radiodiagnosis and Imaging, G.B. Pant Super Specialty Hospital and MAM College, New Delhi-2, India

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   Abstract 

A 32-year-old male presented with a sudden onset of pain in chest, which was tearing in nature. Chest x-ray showed an evidence of cardiomegaly and dilation of descending Aorta. On echocardiography, there was evidence of dissection of Aorta In its root extending into ascending part and arch of aorta: ECG did not show any evidence of Ischaemia. Contrast MR angiography revealed dissection starting from the aortic root till the origin of renal arteries. Patient was put on conservative treatment.

Keywords: MR Angiography, Aortic Dissection

How to cite this article:
Sharma A, Makwane U K, Sharma N. "Aortic dissection-contrast enhanced 3D MR angiography - a case report". Indian J Radiol Imaging 2003;13:147-9

How to cite this URL:
Sharma A, Makwane U K, Sharma N. "Aortic dissection-contrast enhanced 3D MR angiography - a case report". Indian J Radiol Imaging [serial online] 2003 [cited 2019 Jul 17];13:147-9. Available from: http://www.ijri.org/text.asp?2003/13/2/147/28648

   Introduction Top


Aortic dissection is caused by circumferential or less frequently linear tear of the intima. It occurs along the right lateral wall of ascending Aorta where the hydraulic shear stress is high. The initiating event is either a hemorrhage into the media that dissects into and disrupts the intima or a primary tear with secondary dissection into the media [1]. Patients generally present in 6th and 7th decade and M:F ratio is 2:1 Patients present with sudden onset of pain, severe tearing associated with diaphoresis. The pain is localized to the front or back of the chest, the interscapular region and typically migrates with propagation of dissection.


   Case report Top


A 32-year-old male presented with a severe chest pain with associated diaphoresis. The pain was also extending into the upper abdomen. Physical findings showed an evidence of hypertension and Aortic regurgitation.

ECG was normal.

X ray chest showed Cardiomegaly [Figure - 1].

Echo- cardiography suggested the evidence of aortic dissection starting from the aortic root, involving ascending and arch of Aorta. Contrast MR angiography using 20ml Gd was performed with 3D T1 weighted bolus tracking technique. MR showed dissection starting from the Aortic root, involving whole of the ascending Aorta, proximal Right brachiocephalic artery, arch of Aorta, descending aorta till the orgin of the renal arteries. Dissection was not extending into abdominal aortic branches. Ulcers were seen. Thrombosis was also detected measuring approx 11-13 mm. Inter leaf thickness was 2.9 mm, false lumen 4-6 mm & true lumen 19.6 mm [Figure - 5] Total length of dissection was approximately 15 cm- [Figure - 2],[Figure - 3],[Figure - 4] Patient was managed conservatively and is performing his routine work till to date


   Discussion Top


Predisposing factors for dissection are systemic hypertension and cystic medial necrosis. Major causes of morbidity and mortality are in patients with congenital aortic valve anomalies, coarctation of Aorta and normal women during 3rd trimester of pregnancy. Pathologic variants are intramural hematoma without an intimal flap and pentrating ulcer. De Bakey and coworkers have classified dissection into three types-Type 1-intimal tear in ascending aorta but which involves descending aorta also.Type-2-dissection limited to ascending aorta.Type3-is located in descending aorta with distal propagation of the dissection[1].Stanford classified dissection into Type A-involves ascending aorta(proximal dissection). Type B-limited to descending aorta(distal dissection)[1]

Various imaging modalities used for its diagnosis are chest x-ray, ECG, Aortography, Echocardiography, CT and MRI. Aortagraphy depicts the entry point, the intimal flap, and the false and true lumen. It establishes the extent of dissection into major arteries. Its sensitivity is 70 % for intimal flap, 56% for the site of intimal tear, 87% for the false lumen. It unable to recognize intramural is hemorrhages [1] and an invasive procedure. Trans- thoracic echocardiography is 60 to 85% accurate in identifying dissection of ascending and descending thoracic aorta but not the arch of Aorta[2].CT and MRI can demonstrate intimal flap and extent of dissection, recognizing intramural hemorrhage and penetrating ulcer [3] MRA is an excellent modality to assess these patients with 2D TOF and 3D-enhanced techniques[4]

It classifies the dissection, defines entry and re-entry point, differentiates thrombus from slow flow and evaluates branch Vessel involvement [5]. to n In the present case we have used Contrast-enhanced 3-D technique. We have used a coronal approach since Gadolinium-enhanced MR techniques rely on shortening of T 1 and not on flow. They are only minimally susceptible to the in-plane flow and other artifacts[4],[6].We have used 20 ml contrast injected at rate of 2cc/sec using a power injector, in order to optimize bolus timing/real time fluoroscopy.

 
   References Top

1.Goodwin JD, Hertfkens RL etal. Evaluation of dissections and aneurysm of the thoracic aorta by Conventional and dynamic Ct scanning. Radiology 1980,136:125.  Back to cited text no. 1    
2.Bogaert J Meyns B, Rademakers Fe, etal. Follow-up of aortic dissection: contribution of MR angiography for evaluation of abdominal aorta and its branches .Fur radiology 1997; 7: 695-702.  Back to cited text no. 2    
3.Vosshenrich R, Fischer U. contrst-enhanced MR angiography of abdominal vessels: is there still a role for angiography. Euro Radiol 202; 12;218-230.  Back to cited text no. 3    
4.Blashbalg R, Mitchell DG, Outwater EK, etal. Free MRA of abdomen: postprocessingdynamic Cd-enhanced 3D axial MR images Abdom Imaging 2002; 25: 62-66  Back to cited text no. 4    
5.Gilfeather M, Holland CA, Siegelman Es, etal, Gadolinuim enhanced ultrafast three-dimensional spoiled-gradient- echo MR imaging of abdominal Aorta and visceral and iliac Vessels. Radiographics 1997,(3):804  Back to cited text no. 5    
6.Cambria RP, Brewster DC, Gertper J. Vascular complications associated with spontaneous aortic dissection. J Vasc Sur 1988;7: 199-209.  Back to cited text no. 6    

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Correspondence Address:
A Sharma
C-10 Kendriya Vihar, Sector 51, Noida 201 307
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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[Pubmed]



 

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    Abstract
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