Primary aorto-duodenal fistula is a rare and life-threatening cause of upper gastro-intestinal bleed. In this case report, a patient presented acutely with several episodes of haematochezia and pulseless lower limbs bilaterally. Primary aorto-duodenal fistula with peripheral vascular disease was diagnosed after an urgent CT angiogram was performed. She underwent left axillo-bifemoral bypass, resection of the fistula, Rouxen-Y gastro-jejunostomy, pyloric exclusion and controlled duodenal fistula the following day.
Aortic Diseases/*diagnosis ; Duodenal Diseases/*diagnosis ; Intestinal Fistula/*diagnosis

Tuberculous-infected aortic aneurysms are rare, but delayed diagnosis can lead to serious complications, including sudden aortic rupture. Here, we report a case of a tuberculous infected aneurysm in the thoracic aorta that was mistaken for lymphadenopathy. In this case, we could differentiate the lesion with the aid of contrast-enhanced computed tomography and positron emission tomography (PET). This case demonstrates the diagnostic value of PET in aortic aneurysms.
Aneurysm, Infected* ; Aorta, Thoracic* ; Aortic Aneurysm ; Aortic Rupture ; Delayed Diagnosis ; Lymphatic Diseases* ; Mycobacterium tuberculosis ; Positron-Emission Tomography

PURPOSE: MRI is known to be an effective imaging modality of the aorta and its role is steadily increasing in the evaluation of acquired aortic diseases including aortic dissections and aortic aneurysms. However, differentiation of the aortic dissections with thrombosed false lumen from the aortic aneurysm with mural thrombus in MRI has not been easy. Therefore, the authors tried to find the characteristic MR featrses which would to differentiate the two diseases. MATERIALS AND METHODS: MR images of 6 patients with thrombosed aortic dissection and 7 patients with thrombosed aortic aneurysms were reviewed retrospectively and compared in regand to shape and extent of thrombus, dimension of aorta, and luminal flow signal. RESULTS: Thrombosed aortic dissections showed sharply demarcated crescent shaped aortic wall thickening of even thickness involving long segment of the aorta, whereas thrombosed aortic aneurysms showed irregular aortic wall thickening of uneven thickness localized in the short dilated segment of the aorta. Characteristically aortic aneurysm with mural thrombus showed eccentric intraluminal slow flow signal. In contrast to the signal void of the true lumen in aortic dissections, the residual lumen of the aortic aneurysm with mural thrombus revealed intraluminal signal due to slow flow. CONCLUSION: Familiarity to these MRI findings of thrombosed aortic dissections and aortic aneurysms may lead to the accurate differential diagnosis in majority of cases.
Aorta ; Aortic Aneurysm* ; Aortic Diseases ; Diagnosis, Differential* ; Humans ; Magnetic Resonance Imaging* ; Phenobarbital ; Recognition (Psychology) ; Retrospective Studies ; Thrombosis

PURPOSE: The purpose of this study was to investigate the frequency, site and characteristics of motion artifact of ascending aorta mimicking dissection. MATERIALS AND METHODS: The authors evaluated postcontrast CT scans of 60 cases in 60 patients without symptoms of aortic dissection or aortic disease. A Toshiba 900S scanner was used, with 1 cm slice thickness and 1 sec scan time. Streak artifacts, and those relating to extra-aortic vascular structure or pericardial effusion were excluded from this study. RESULTS: Crescent-shaped motion artifacts were seen in 54 cases (90%), and occurred from 1 cm to 4 cm above the level of the aortic valve; between men and women, there was no significant difference in frequency. In each case, the artifact was seen at 1 to 5 (mean 2.9) levels. Its pattern was symmetric in 31 of 60 cases (51%), and at 15 other sites, symmetric artifacts were seen between the SVC and ascending aorta. At the margin of the aortic circumference, the direction of the artifact was left anterior-right posterior in 23.9% of cases, and anterior median-posterior median in 20.8%. CONCLUSION: On CT, motion artifact of ascending aorta occurs frequently. Findings relating to location, symmetric pattern and characteristic direction of artifact may be helpful in the differential diagnosis of aortic dissection and aortic motion artifact.
Aorta* ; Aortic Diseases ; Aortic Valve ; Artifacts* ; Diagnosis, Differential ; Female ; Humans ; Male ; Pericardial Effusion ; Tomography, X-Ray Computed

BACKGROUND: Rapid and accurate diagnosis is essential for successful management of acute aortic dissection. As transesophageal echocardiography(TEE) provides excellent imaging of thoracic aorta conveniently, TEE is widely indicated as a effective diagnostic method of aortic disease. To evaluate clinical usefulness of TEE in patients with suspected aortic dissection, we assessed diagnostic accuracy and feasibility of TEE. METHODS: Ninety-one consecutive patients with clinically suspected aortic dissection were examined by TEE, computerized tomography(CT), magnetic resonance imagion(MRI) and aortic angiography between August 1991 and September 1994. The diagnosis was confirmend by these techniques and surgery. RESULTS: 1) We diagnosed 27 proximal aortic dissection, 22 distal aortic dissection, 8 aortic intramural hematioma, 12 thoracic aortic aneurysm, 2 penetration ulcer, 1 necrotizing aortitis, 1 traumatioc aortic rupture and 18 normal findings in 91 study patients. 2) The sensitivity and specificity of TEE for aortic dissection were 98% and 97%, respecitively. The sensitivity and specificity of TEE to detect ascending aorta involvement were 94% and 100%. 3) CT was chosen in 62 cases as primary diagnostic method of aortic dissection, whereas TEE was performed in 21 cases. TEE was chosen as confirmative diagnostic method following CT in 45 cases, in one-third of whom TEE played a great role in diagnosis or decision of treatment modality. CONCLUSION: As TEE is and accurate and practical method in diagnosis of aortic dissection, TEE may be suggested as primary diagnostic method in suspected aortic dissection. TEE was also useful as confirmative diagnostic method complemention CT.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortic Rupture ; Aortitis ; Complement System Proteins ; Diagnosis* ; Echocardiography, Transesophageal* ; Humans ; Sensitivity and Specificity ; Ulcer

Acute Disease ; Adult ; Aortic Diseases ; diagnosis ; etiology ; Arterial Occlusive Diseases ; diagnosis ; etiology ; Heart Neoplasms ; complications ; Humans ; Male ; Myxoma ; complications

Due to its low prevalence and because there is lack of awareness about it, Loeys-Dietz syndrome is often mis-diagnosed as Marfan syndrome, which has similar skeletal abnormalities and aortic pathology. However, the differential diagnosis between these two connective tissue diseases is critical because they correspond to different surgical indications and surgical decision-making. We report two cases of successful thoracoabdominal aortic replacement in patients with previously undiagnosed Loeys-Dietz syndrome.
Aortic Aneurysm ; Connective Tissue Diseases ; Diagnosis, Differential ; Humans ; Loeys-Dietz Syndrome* ; Marfan Syndrome ; Pathology ; Prevalence

In order to assess the sensitively and specificity of the pulsed Doppler echocardiography in the aortic regurgitation, 44 patients with valvular heart diseases were examined by pulsed Doppler echocardiography. Every patient was examined in sequence of clinical examination including the physical, M-mode & 2D echocardiographic examination, Doppler technique and then angiocardiography. The obtained results were; 1) Pulsed Doppler echocardiography was very useful in the diagnosis of the aortic regugitation(sensitivity:100%, specificity:90%). 2) Pulsed Doppler echocardiography was especially useful in the detection of the aortic regurgitation in patients who were not detected by physical and conventional echocardiographic examination.
Angiocardiography ; Aortic Valve Insufficiency* ; Diagnosis* ; Echocardiography ; Echocardiography, Doppler, Pulsed* ; Heart Valve Diseases ; Humans ; Sensitivity and Specificity

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta whitch originates just distal to the level of the origins of the coronary arteries, and whitch includes a wide spectrum of pathologic changes. A 27 years-old-female was admitted because of further evaluation of known some heart disease. Clinical diagnosis of supravalvular aortic stenosis was made by echocardiography and angiography. We presented a case of supravalvular aortic stenosis with a review of literature.
Angiography ; Aorta ; Aortic Stenosis, Supravalvular* ; Congenital Abnormalities ; Coronary Vessels ; Diagnosis ; Echocardiography ; Heart Diseases

Endovascular aortic repair is often performed for the treatment of aortic disease because of less invasiveness and fewer complications. Cardiac tamponade is a fatal disease that can lead to death if not treated properly. Cardiac puncture by rigid guide wire used in endovascular aortic repair may cause cardiac tamponade. Rapid diagnosis and treatment are needed when cardiac tamponade occurs. Confirmation of the cardiac tamponade can be accomplished with echocardiography. Continuous echocardiography should be monitor for detection of cardiac complications during endovascular aortic repair.
Aneurysm, Dissecting ; Aortic Diseases ; Cardiac Tamponade ; Diagnosis ; Echocardiography ; Endovascular Procedures ; Punctures ; Rupture