Chapter30 Aorta

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Chapter 30: Thoracic Aorta

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Figure 30.26.  Areas of Ulcerated Plaque in a 65-Year-Old Man. Parasagittal ( A ) and axial ( B ) CT images of the aorta show extensive layering, mixed but predominantly noncalcified plaque throughout the thoracic aorta ( white arrows ). In certain areas, contrast can be seen extending into the plaque ( yellow arrows ) but does not extend beyond the intima, which is demarcated by a thin calcification along the aortic wall ( white arrow- heads ). It is important to differentiate this ulcerated plaque from penetrating atherosclerotic ulcers, as they have different treatments.

Symptoms are nonspecific but are usually secondary to complication such as rupture, aortic regurgitation, or com- pression of adjacent cardiovascular structures. Rupture often occurs into a cardiac structure, most commonly the right ven- tricle and right atrium. This results in a left-to-right shunt with development of heart failure. Early surgical or endovascular repair is essential, as mean survival after rupture is 1 to 2 years.

and Loeys–Dietz syndromes (Fig. 30.27). Congenital aneu- rysms are also associated with bicuspid aortic valve and VSD. Acquired sinus of Valsalva aneurysms often represent pseudo- aneurysms and result from bacterial aortic valve endocarditis or aortic surgery. Dilation of the sinuses may be diffuse and cir- cumferential or eccentric, focally involving one of the coronary sinuses. The right sinus of Valsalva is involved in 70% of cases.

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Figure 30.27.  Sinus of Valsalva Aneurysm. Coronal oblique CTA in a patient with chest pain and no significant past medical history shows a large aneurysm arising from the left sinus of Valsalva ( A , arrow ). Still image from a coronary angiography shows that the large sinus of Valsalva aneurysm stretches and narrows the left anterior descending coronary artery ( B , arrow ). The patient’s symptoms resolved after surgical repair.