Acute aortic syndrome (AAS) describes the presentation of patients with one of a number of life threatening aortic pathologies that give rise to aortic symptoms.
The spectrum of these aortic emergencies include:
aortic intramural haematoma
penetrating atherosclerotic ulcer
Acute occlusion of the basilar artery may cause brainstem or thalamic ischaemia or infarction. It is a true neuro-interventional emergency and, if not treated early, brainstem infarction results in rapid deterioration in the level of consciousness and ultimately death.
Human alpha fetoprotein (AFP) elevation may occur in a vast number of conditions:
liver tumours (hepatocellular carcinoma, hepatoblastoma)
<10 ng/ml is within normal limits
>20 ng/ml is above normal limits but has low specificity for tumor since it may occur in a setting of diffuse liver inju...
Anterior inferior cerebellar artery (AICA) territory infarcts are much less common than posterior inferior cerebellar artery (PICA) infarcts.
AICA territory infarcts are rare, comprising ~1% of ischaemic cerebellar strokes 2.
AICA stroke syndrome presents ...
Artery of Percheron territory infarct is rare, on account of the relative rarity of the artery of Percheron, and presents with a variety of signs and symptoms collectively termed the paramedian thalamic syndrome. It is a type of posterior circulation infarction.
On imaging, it is classically ch...
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 referred as extracranial carotid artery stenosis, is usually caused by an atherosclerotic process and is one of the major causes of stroke and transient ischemic attack (TIA) 1.
This article refers to stenosis involving carotid bulb and the proximal segment of inte...
Carotid pacemaker, also known as implantable carotid sinus stimulators, is a device that delivers activation energy through the carotid leads and the leads conduct activation energy to the carotid baroreceptors. This is sometimes offered for drug-resistant hypertension. The baroreceptors send si...
Causes of a small aorta include:
giant cell arteritis
small aorta syndrome
There are relatively few causes of calcification of the ascending aorta 1-3:
atherosclerosis (this usually spares the ascending aorta)
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)
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognised, especially asymptomatic variants 1.
The clinical ...
A coronary artery bypass graft (CABG or CAG) is placed during a surgical procedure to increase blood flow to the myocardium due to coronary stenoses, usually caused by coronary artery disease. Arteries or veins can be grafted during this procedure.
Long term outcome of coronary artery bypass gr...
The differential diagnosis of vascular calcification is very wide with many common and uncommon conditions.
end-stage renal failure 3
hemangioma; arteriovenous malformation
hyperparathyroidism, primary or secondary (renal osteodystrop...
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.
Causes for dilatation
There are a number of physiological causes for e...
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 refers to coughing out blood. Generally, it appears bright red in colour as opposed to blood from gastrointestinal tract which appears dark red. It is considered an alarming sign of a serious underlying aetiology.
Massive haemoptysis is referred to as expectoration of >...
A hepatic lymphangioma is a rare benign condition that corresponds to focally dilated lymphatic channels in the liver.
Most cases are asymptomatic.
A lymphangioma is a benign lesion that can occur at almost any location in the body. Hepatic involvement is les...
Hyper-reninaemic 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)
Iliac vein occlusion can be due to the variety of causes including:
catheter dissection injuries
IVC filter insertion
direct tumour invasion
enlarged lymph nodes
Innominate artery compression syndrome, also known as brachiocephalic artery compression syndrome, is a rare cause of tracheal stenosis that occurs in the paediatric population.
It can only occur in the presence of an aberrantly positioned thymus that forces the aortic arch or innomi...
When a central venous catheter that is supposed to project over the superior vena cava is abnormally located to the left of the mediastinum a limited differential of left paramediastinal catheter position should be considered 1:
located within the vein
left sided superior vena cava
Lower gastrointestinal bleeding usually occurs distal to the ligament of Treitz.
Presents with melaena, haematochezia or, if subclinical slow bleeding, chronic anaemia.
Medical devices in the neck are regularly observed by radiologists on plain film and CT reporting. They include devices which pass through the neck onto the chest and stomach.
Vascular access devices
peripherally inserted central catheters (PICC)
central venous catheters
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 results in 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.
Partial anomalous pulmonary venous return (PAPVR), also known as partial anomalous pulmonary venous connection (PAPVC), is a rare congenital cardiovascular condition in which some of the pulmonary veins, but not all, drain into the systemic circulation rather than in the left atrium.
Pericardial calcification (PC) 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 radiography, location ...
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...
Portal venous gas is the accumulation of gas in the portal vein and its branches. It needs to be distinguished from pneumobilia, although this is usually not too problematic, when associated findings are taken into account along with the pattern of gas (i.e. peripheral in portal venous gas, cent...
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 infarction is most commonly caused by pulmonary embolism (PE) in combination with chronic left heart failure.
The demographics of affected patients are older than those of patients with 'simple' pulmonary embolism (PE) as young patients with no comorbidities are usually ...
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)
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
Renovascular hypertension (RVH) is a type of secondary hypertension, where high blood pressure develops secondary to renal artery disease.
Approximately 2.5% (range 0.5-5%) of hypertensive patients will have RVH as a cause 2,3.
There are a number of condit...
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 characterized 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 term...
Tear drop sign of the superior mesenteric vein (SMV) is one of the important signs in the staging of pancreatic adenocarcinoma. Its importance lies in its diagnosis as well as prognostic significance. This sign is used in assessing the resectability of pancreatic cancer.
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
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 (VAA) are abnormal focal dilatations of arteries supplying an organ in the abdomen. VAAs include both true and pseudoaneurysms.
With different clinical manifestations and a more characteristic pathology, the renal artery aneurysms are discussed separately.
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...