Disseminated intravascular coagulation (DIC) is an acquired coagulation disorder that occurs when the normal hemostatic balance is disturbed, primarily by excessive thrombin formation. Moreover, while DIC is a rare complication of aortic dissecting aneurysm, it is also a well-recognized one. We reported a case of DIC associated with aortic dissecting aneurysm in a 55-year-old woman who was transferred from another hospital because of chest pain radiating to her back and thrombocytopenia. Laboratory findings showed DIC with severe thrombocytopenia, and she was diagnosed as having an acute aortic dissection and DIC. After medical treatment on the aortic dissecting aneurysm, her DIC profile recovered.
Aneurysm, Dissecting/*complications/radiography ; Aortic Aneurysm, Thoracic/*complications/radiography ; Disseminated Intravascular Coagulation/*complications/radiography ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.
Accidents, Traffic ; Adult ; Aneurysm, False ; Aorta, Thoracic/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Cerebral Hemorrhage/radiography/surgery ; Endovascular Procedures/*methods ; Humans ; Male ; Subclavian Artery/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds, Nonpenetrating/radiography/surgery

OBJECTIVE: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT). MATERIALS AND METHODS: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations. RESULTS: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers. CONCLUSION: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.
Aged ; Aortic Aneurysm/radiography ; *Coronary Angiography ; Female ; Humans ; Image Processing, Computer-Assisted ; *Incidental Findings ; Liver Diseases/radiography ; Lung Diseases/radiography ; Male ; Middle Aged ; *Tomography, X-Ray Computed

A right-sided aortic arch (RAA) is a rare congenital anomaly, and Stanford type B dissection aneurysms involving this anomaly is also uncommon. Surgical approaches to dealing with an RAA are complicated by the unusual anatomical features of the condition. Here we report the case of a 47-year-old male who had a type B dissecting aneurysm involving an RAA with Kommerell's diverticulum. Graft replacement was successfully performed with an uneventful postoperative course.
Aneurysm, Dissecting/radiography/*surgery ; Aorta, Thoracic/*abnormalities/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Diverticulum/radiography/*surgery ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Intrathoracic segment of the subclavian artery is an unusual location for peripheral arterial aneurysms. They are normally caused by atherosclerosis, medial degeneration, trauma, and infection. We report a case of a patient with right subclavian artery aneurysm presenting with hoarseness. Chest radiograph demonstrated a superior mediastinal mass. Laryngoscopy showed a fixed right vocal cord. By chest computed tomography, magnetic resonance imaging, and angiography, preoperative diagnosis was established as a saccular aneurysm with afferent loop and efferent loop. Patient underwent complete resection of the aneurysm followed by endto-end anastomosis via median sternotomy. Postoperative pathology was consistent with an atherosclerotic aneurysm filled with thrombus. After surgical operation, hoarseness is still continued.
Aged ; Aortic Aneurysm, Thoracic/complications/*pathology ; Female ; Hoarseness/etiology/*pathology ; Humans ; Magnetic Resonance Imaging/methods ; Subclavian Artery/*pathology/radiography

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.
Aortic Aneurysm/*complications/diagnosis ; Aortic Rupture/*complications/diagnosis ; Constriction, Pathologic ; Female ; Hematoma/*complications ; Human ; Hypertension, Pulmonary/*etiology ; Middle Aged ; Pulmonary Artery/pathology/radiography ; Tomography, X-Ray Computed

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.
Adult ; Aneurysm, Infected/drug therapy/radiography/*surgery ; Antitubercular Agents/therapeutic use ; Aortic Aneurysm, Abdominal/drug therapy/radiography/*surgery ; *Blood Vessel Prosthesis Implantation ; Case Report ; Female ; Human ; Male ; Psoas Abscess/surgery ; *Stents ; Tuberculosis, Cardiovascular/drug therapy/radiography/*surgery

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.
Aged, 80 and over ; Angiography ; Aortic Aneurysm, Abdominal/*therapy ; Aortic Diseases/*etiology/radiography/therapy ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Fistula/*etiology/radiography/therapy ; Gastrointestinal Hemorrhage/therapy ; Humans ; Male ; Stents/*adverse effects ; Tomography, X-Ray Computed

BACKGROUND: Rupture of thoracic aortic aneurysm and dissection into the chest space results in the death of the patient from uncontrolled hemorrhage. The purpose of our study is to evaluate chest radiographic findings that may assist in the rapid detection of nontraumatic disorder in mediastinum and thoracic aorta. MATERIAL AND METHOD: Thirteen consecutive chest radiographs obtained at emergency room of patients with hemorrhage from ruptured thoracic aortic aneurysms or aortic dissections were randomized with radiographs of 8 subjects with nonruptured thoracic aortic aneurysms, 11 subjects with nonruptured aortic dissections, and 20 control subjects. Diagnoses were confirmed by computed tomography(CT) and transesophageal echocardiography(TEE). A retrospective study was performed by assessment of 14 parameters on each of these 52 radiographs to screen the mediastinum and thoracic aortic disorder. RESULTS: Significant difference between patients with mediastinum and thoracic aortic disorder(aneurysm and dissection) and normal subjects occurred in mediastinal/chest ratio>0.25, aortic knob width>4cm, tracheal shift to right loss of paratracheal stripe & azygos vein, and left pleural & extrapleural fluid of chest radiographs(p<0.05). The most useful predictors of mediastinum and thoracic disorder were aortic knob widening above 4cm and combining signs of mediastinum/chest ratio above 0.25 and abnormal aortic arch. These plain radiographic signs had a sensitivity of 9.1~96.9% and a specificity of 40~100% for mediastinum and thoracic aortic disorder. CONCLUSION: The chest radiograph obtained at emergency room remains the best available screening test for mediastinum and thoracic aortic disorder and can be used effectively, though not perfectively, to eliminate unnecessary CT or TEE.
Aorta, Thoracic* ; Aortic Aneurysm, Thoracic ; Azygos Vein ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Mass Screening ; Mediastinum* ; Radiography, Thoracic ; Retrospective Studies ; Rupture ; Sensitivity and Specificity ; Thorax*

Although the use of central venous cannulation has been increasing in recent years, it can produce serious complications such as hemothorax, pneumothorax, arterial puncture, and malposition of the catheter. Therefore, post-procedure chest radiograph must be obtained to confirm correct placement of the catheter and to exclude pneumothorax or hemothorax. We experienced an abnormal course of left subclavian catheter along the left border of the heart on post-procedure chest radiograph. Here we report a case of persistent left superior vena cava detected by hemodialysis catheterization in a patient with acute renal failure after ruptured abdominal aortic aneurysm.
Acute Kidney Injury ; Aortic Aneurysm, Abdominal ; Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Heart ; Hemothorax ; Humans ; Pneumothorax ; Punctures ; Radiography, Thoracic ; Renal Dialysis ; Vena Cava, Superior*