Dilatation of the ascending aorta is a common finding in the elderly but unusual in younger patients.
In adults, an ascending aortic diameter greater than 4 cm is considered to indicate dilatation 4. Aneurysmal dilatation is considered when the ascending aortic diameter reaches or ex...
Carotid artery stenosis also known as extracranial carotid artery stenosis, is usually caused by an atherosclerotic process and is one of the major causes of stroke and transient ischaemic attack (TIA) 1.
This article refers to stenosis involving carotid bulb and the proximal segment of intern...
Carotid pacemakers, also known as implantable carotid sinus stimulators, are devices that deliver activation energy, via carotid leads, to the carotid baroreceptors. This is sometimes offered for drug-resistant hypertension. The baroreceptors send signals to the brain and the signals are interpr...
There are relatively few causes of calcification of the ascending aorta 1-3:
atherosclerosis (this usually spares the ascending aorta)
Causes of a small aorta include:
giant cell arteritis
small aorta syndrome
Vascular malformations of the central nervous system can be divided, as they can elsewhere, into high and low flow malformations.
arteriovenous malformation (AVM)
cerebral AVM (pial/parenchymal AVM)
cerebral proliferative angiopathy
dural arteriovenous fistula (DAVF)
The differential diagnosis of vascular calcification is very wide with many common and uncommon conditions.
end-stage renal failure 3
haemangioma; arteriovenous malformation
hyperparathyroidism, primary or secondary (renal osteodystro...
Endoleaks are characterised by persistent blood flow within the aneurysm sac following endovascular aneurysm repair (EVAR). Normally the aortic stent-graft used for EVAR excludes the aneurysm from the circulation by providing a conduit for blood to bypass the sac.
An endoleak is a...
An enlarged/dilated azygos vein may result from a number of physiological as well as pathological causes. The enlarged azygos vein may be seen as a widened right paratracheal/paraspinal stripe on a frontal chest radiograph.
Spelling it "azygous" when referring to the vein is incorr...
The differential of an enlarged pulmonary trunk/main pulmonary artery on chest radiography includes:
may appear prominent in young patients especially women
rotation of the heart
left lower lobe collapse
pulmonary arterial hyp...
Haemoptysis (plural: haemoptyses) refers to coughing up of blood. Generally, it appears bright red in colour as opposed to blood from the gastrointestinal tract which appears dark red. It is considered an alarming sign of a serious underlying aetiology.
Massive haemoptysis is refer...
Hepatic vascular and perfusion disorders are a broad group of conditions that radiologists should be familiar with, as some of them are quite frequently seen in the daily practice. The aim of this article is to be a collection of articles that represent the core knowledge in the matter.
Hyperreninaemic hypertension may have many causes including:
renal artery stenosis
renal secreting tumour, e.g. renal cell carcinoma, reninoma
renal compression: large renal mass, subcapsular haemorrhage (Page kidney)
Hypervascular liver lesions may be caused by primary liver pathology or metastatic disease.
hepatocellular carcinoma (HCC)
most common hypervascular primary liver malignancy
early arterial phase enhancement and then rapid wash out
rim enhancement of c...
Iliac vein occlusion can be due to a variety of causes including:
catheter dissection injuries
IVC filter insertion
direct tumour invasion
enlarged lymph nodes
Intrahepatic arteriovenous shunts, also referred to as intrahepatic arteriovenous malformations (AVMs) or hepatic arteriosystemic venous shunts, represent a spectrum of abnormal communications between the hepatic arterial system and the hepatic veins.
Please note that arterioportal shunts, whi...
When a central venous catheter that is supposed to terminate in the superior vena cava or right atrium is abnormally located to the left of the mediastinum and below the level of the brachiocephalic vein, a limited differential of left paramediastinal catheter position should be considered 1:
Lower gastrointestinal bleeding usually occurs distal to the ligament of Treitz, and has a wide differential diagnosis:
Medical devices in the neck are regularly observed by radiologists on plain film and CT reporting. They include devices which pass through the neck into the chest and stomach or ascend to/into the head.
Vascular access devices
peripherally inserted central catheters (PICC)
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc. may also be visible
Moyamoya syndrome, also termed the moyamoya pattern or phenomenon, is due to numerous conditions that can cause arterial occlusion of the circle of Willis, with resultant collaterals, and appearances reminiscent of moyamoya disease. These conditions include 1-4 :
vessel wall abnormalities
Oxalosis is supersaturation of calcium oxalate in the urine (hyperoxaluria), which in turn results in nephrolithiasis and cortical nephrocalcinosis.
This article focus on the secondary oxalosis, please refer to primary oxalosis for a specific discussion on this entity.
Pericardial calcification usually occurs in patients with a history of pericarditis.
previous trauma or prior pericarditis
later sequelae of rheumatic heart disease
malignant pericardial involvement (e.g. mediastinal teratoma)
On chest rad...
Phleboliths are literally "vein stones", and represent calcification within venous structures. They are particularly common in the pelvis where they may mimic ureteric calculi, and are also encountered frequently in venous malformations. There is an association with Maffucci syndrome.
Polymyalgia rheumatica (PMR) is a common inflammatory condition typically affecting elderly people. It is a multisystem disorder but usually affects the musculoskeletal system.
It can manifest in various ways, which are best discussed in the separate articles below:
polymyalgia rheumatica (mus...
Pulmonary arterial calcification is the phenomenon which is usually seen in the setting of advanced pulmonary hypertension. It can however be uncommonly present in those without pulmonary hypertension.
The general mechanism in the vast majority is thought to be from high end pulmonar...
Pulmonary hypertension has many causes, and these can be divided in many ways. A simple and systematic approach is to proceed along the cardiopulmonary pulmonary circulation, as causes are found at each site (for a more official classification system see 2003 third world symposium on pulmonary a...
Pulmonary vasculitis refers to vasculitides that affect the lung or pulmonary vessels. If this definition is used, a large group of conditions can fall into this category. The respiratory system may be potentially involved in all systemic vasculitides, although to a variable degree.
Pulsatile tinnitus is a specific type of tinnitus and refers to the perception of rhythmic noise, usually in time with the patient's heartbeat, in the absence of an external source, which is most commonly but not exclusively due to underlying vascular pathology.
Renal artery dissection may occur as a result of the following processes 1:
aortic dissection extending to involve the renal artery
iatrogenic (e.g. catheterisation)
connective tissue disease (eg. Marfan syndrome)
Renal artery stenosis (RAS) refers to a narrowing of a renal artery. When the process occurs slowly, it leads to secondary hypertension. Acute renal artery stenosis does not lead to hypersecretion of renin.
When the stenosis occurs slowly, collateral vessels form and supply the kidne...
Renal vein varices develop for various reasons and are usually asymptomatic.
Renal vein varices are usually asymptomatic. Some patients may present with flank pain and/or haematuria.
chronic renal vein thrombosis
Retroperitoneal lymphangiomas are rare benign cystic lesions of vascular origin that show lymphatic differentiation.
For a broader discussion, please refer to the parental article on lymphangioma.
Only about 1% of all lymphangiomas occur in the retroperitoneal space. Abdominal ...
Soft-tissue sarcomas are a heterogeneous group of malignant tumours of mesenchymal origin (sarcoma) that originate from the soft tissues rather than bone. They are classified on the basis of tissue seen on histology. The commoner sarcomas in the adult and paediatric population are listed below.
Spinal vascular malformations (SVM) are rare but knowledge of them is important as if undiagnosed and untreated they can lead to serious complications.
There are two main types of SVMs 1,2:
spinal arteriovenous fistula (AVF): 70% of SVMs
pial: small, large, or giant
dural AVF (DA...
Superficial thrombophlebitis, also called superficial venous thrombosis (SVT), is a pathological condition characterised by the presence of a thrombus in the lumen of a superficial vein, accompanied by inflammatory reaction of adjacent tissues.
Some authors, however, reserve the te...
Third inflow refers to anatomical variants leading to an additional venous inflow to the liver apart from the usual dual blood supply (portal vein and hepatic artery). They tend to be associated with parenchymal pseudolesions (focal hyperenhancement on post-contrast imaging, focal fat infiltrati...
There are a number of causes and mimics of thoracic aortic dilatation.
post-stenotic dilatation, e.g. bicuspid aortic valve
thoracic aortic aneurysm
atherosclerosis (usually descending thoracic aorta)
The differential for thoracic aortic stenosis includes:
aortitis (especially Takayasu arteritis)
Williams syndrome: supravalvular aortic stenosis
congenital rubella syndrome: supravalvular aortic stenosis
An upper gastrointestinal bleed usually refers to bleeding proximal to the ligament of Treitz.
The Valsalva manoeuvre is the forced expiration of air against a closed airway, resulting in increased intra-abdominal, intrathoracic and pharyngeal pressure. It can be performed against a closed glottis or by one closing the mouth and pinching the nose while forcibly exhaling.
It is commonly u...
Vascular rings and slings refer to the congenital vascular encirclement of the oesophagus and/or trachea by anomalous/aberrant vessels.
Vascular rings are rare, occurring in <1% of patients 1. No gender or ethnic predispositions have been identified 3.
Venous thromboembolism covers a wide spectrum of diseases. Individual conditions and complicating condition include:
deep vein thrombosis (DVT)
pulmonary embolism (PE)
dural venous sinus thrombosis
Visceral artery aneurysms are abnormal focal dilatations of arteries supplying abdominal organs. Visceral artery aneurysms include both true aneurysms and pseudoaneurysms.
Owing to different clinical manifestations and a unique, specific, pathology, renal artery aneurysms are discussed separate...
White coat hypertension (abbreviated alternatively as WCH or WCHT), not to be confused with the white coat effect (WCE), is commonly defined as typical in-clinic blood pressure (BP) measurements of 140/90 mm Hg or more in the presence of multiple daytime out-of-clinic home or ambulatory BP readi...