When issuing an MRI or CT report on a patient with an aortic aneurysm, whether it be thoracic or abdominal, a number of features should be mentioned to aid the referring clinician in managing the patient.
Reporting tips for aortic aneurysms include 1,2:
- size and shape
- sac dimensions (outer surface to outer surface)
- luminal diameter if mural thrombus is present
- length 3
- fusiform or saccular
- size of vessel proximal and distal to aneurysm
- characteristics of wall
- mural calcification
- presence of mural thrombus
- location and relationship to involved branches/structure
- characterization of possible etiology
- true or false
- possibility of mycotic etiology
- other relevant vessels
- thoracic aortic aneurysms
- access vessels for endovascular repair (EVAR) which usually requires bilateral common femoral artery (CFA) punctures and vessel diameters of 6 mm or greater
The infrarenal aorta demonstrates a fusiform aneurysm which measures 6 x 7 cm (AP x LR) and extends over a distance of 7.5 cm. It begins 2.3 cm distal to the renal arteries (aorta at this level measures 2.1 cm) and terminates at the aortic bifurcation without extension into the iliac arteries (right CIA = 1.2 cm, left CIA = 1.1 cm).
Smooth eccentric mural thrombus is present within the aneurysm, thickest on the right where it measures 1.5 cm. The lumen has a diameter of 4.5 x 6 cm (AP x LR). There is no surrounding stranding or extravasation of contrast to suggest impending rupture.
The aorta and other visualized vessels demonstrate widespread atherosclerosis, suggesting that this is the underlying etiology of the AAA. Moderate (<50%) stenosis is seen at the origin of the right renal artery and celiac trunk.
The common femoral arteries bilaterally demonstrate calcific atherosclerosis but no stenosis. High-grade stenosis is however present in the right external iliac artery, potentially posing problems for endovascular access on this side.
- 1. Collins J, Stern EJ. Chest radiology, the essentials. Lippincott Williams & Wilkins. (2007) ISBN:0781763142. Read it at Google Books - Find it at Amazon
- 2. Atar E, Belenky A, Hadad M et-al. MR angiography for abdominal and thoracic aortic aneurysms: assessment before endovascular repair in patients with impaired renal function. AJR Am J Roentgenol. 2006;186 (2): 386-93. doi:10.2214/AJR.04.0449 - Pubmed citation
- 3. Heuts S, Adriaans BP, Rylski B, et al. Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection. (2020) Heart (British Cardiac Society). 106 (12): 892-897. doi:10.1136/heartjnl-2019-316251 - Pubmed
Related Radiopaedia articles
- acute aortic syndrome
- thoracic aortic aneurysm
- abdominal aortic aneurysm
- endovascular aneurysm repair (EVAR)
- reporting tips for aortic aneurysms
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury