Chapter30 Aorta

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Chapter 30: Thoracic Aorta

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Figure 30.44.  Aortoesophageal Fistula in a Woman Presenting With Hematemesis 3 Months After Endovascular Stent Placement. Noncontrast parasagittal CT image ( A ) shows a high-density mediastinal collection ( white arrow ) due to hematoma between the esophagus and descending thoracic aorta. Complex air and fluid collections are present, surrounding the thoracic endovascular stent (TEVAR, yellow arrows ). Parasagittal contrast-enhanced image from the same study ( B ) shows absence of a large portion of the posterior wall of the esophagus ( yellows arrow ) with adjacent hemorrhage, air, and phlegmon. An esophagogastric tube is present ( white arrow ). The intact esophageal wall is seen both superior and inferior to the defect ( red arrows ).

As mentioned above, CT findings in ATAI may vary. On the mildest end of the spectrum is minimal intimal injury, which describes a focal hematoma/minimal filling defect at the luminal margin. ATAI may also manifest as IMH, which is described in greater detail above (“Acute Aortic Syndrome”). More severe injuries include traumatic pseudoaneurysm or even complete transmural disruption of all mural layers

for example, an unstable pelvic injury with high suspicion for vascular injury. TEE, intravascular ultrasound (IVUS), and MRA are typically secondary modalities due to higher invasiveness, longer imaging times, and limited availability. Transthoracic echocardiography (TTE) is an easier and more rapid modality but is useful only in the setting of ascending aortic injury.

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Figure 30.45.  Aortopleural Fistula. Axial CT image ( A ) shows a distal descending thoracic aortic dilation with contour irregularity and periaortic hematoma compatible with a ruptured mycotic aneurysm ( black arrow ). Note the large right pleural effusion with heterogeneous high attenuation consistent with hemothorax ( white arrows ). Patient was emergently stented ( B ).