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    Semiology of Vessels Imaging

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    Sothearith Then
    The document discusses various vascular pathologies that can be identified on medical imaging. It describes dilatations like aneurysms which can be fusiform or saccular in shape. Narrowings include stenoses and occlusions. Congenital malformations of vessels are also discussed. Specific vessel pathologies covered include aneurysms of the aorta, carotid artery, vertebral artery and abdominal aorta. Stenoses of arteries like the renal, carotid and vertebral arteries are also summarized. Imaging modalities to diagnose these conditions using ultrasound, CT, MRI, angiography are presented.

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    Semiology of Vessels Imaging

    Uploaded by

    Sothearith Then
    8 views52 pages
    The document discusses various vascular pathologies that can be identified on medical imaging. It describes dilatations like aneurysms which can be fusiform or saccular in shape. Narrowings include stenoses and occlusions. Congenital malformations of vessels are also discussed. Specific vessel pathologies covered include aneurysms of the aorta, carotid artery, vertebral artery and abdominal aorta. Stenoses of arteries like the renal, carotid and vertebral arteries are also summarized. Imaging modalities to diagnose these conditions using ultrasound, CT, MRI, angiography are presented.

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    The document discusses various vascular pathologies that can be identified on medical imaging. It describes dilatations like aneurysms which can be fusiform or saccular in shape. Narrowings include stenoses and occlusions. Congenital malformations of vessels are also discussed. Specific vessel pathologies covered include aneurysms of the aorta, carotid artery, vertebral artery and abdominal aorta. Stenoses of arteries like the renal, carotid and vertebral arteries are also summarized. Imaging modalities to diagnose these conditions using ultrasound, CT, MRI, angiography are presented.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views52 pages

    Semiology of Vessels Imaging

    Uploaded by

    Sothearith Then
    The document discusses various vascular pathologies that can be identified on medical imaging. It describes dilatations like aneurysms which can be fusiform or saccular in shape. Narrowings include stenoses and occlusions. Congenital malformations of vessels are also discussed. Specific vessel pathologies covered include aneurysms of the aorta, carotid artery, vertebral artery and abdominal aorta. Stenoses of arteries like the renal, carotid and vertebral arteries are also summarized. Imaging modalities to diagnose these conditions using ultrasound, CT, MRI, angiography are presented.

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    of 52

    SEMIOLOGY OF VESSELS

    IMAGING
    SEMIOLOGY OF VASCULAR SYSTEM
    • DILATATION
    - Aneurysm
    - Dissection
    • NARROWING
    - Stenosis
    - Occlusion
    - External compression
    • CONGENITAL MALFORMATION
    - Left arch/ aberrant right subclavian
    - Right arch / aberrant left subclavian artery
    - Right arch with mirror image branching
    - Coartation / pseudocoartation (aortic kink)
    Dilatation of artery
    • Dilatation of artery wall.

    • Divided into 3 types:


    - True aneurysm (three layers intact)
    - False /pseudo- aneurysms
    (disruption of all 3 layers )
    - Inflammation
    Dilatation of artery
    Dilatation of artery

    TYPE OF ANEURYSM / SHAPE

    THERE IS TWO TYPE OF


    ANEURYSM SHAPE :

    1- Fusiform

    2- Saccular
    Dilatation of artery
    Dilatation of artery
    RUPTURE RISK OF ANEURYSM

    • Diameter (> 6cm)


    • Expansion (> 0.6 cm / year)
    • Smoking / COPD
    • Family history
    • Hypertension
    • Gender (Female )
    • Shape (Fusiform < saccular)
    Dilatation of artery
    DIAGNOSIS OF ANEURYSM
    • Physical examination (mass / pulse…)
    • X-Ray (calcification wall / enlargement..)
    • Ultrasound / Doppler US
    • ACT (Angiogram Computed Tomography)
    • MRA (Magnetic Resonance Angiogram)
    • Angiography (Therapeutic/ evaluate)
    Dilatation of artery

    DIAGNOSIS OF ANEURYSM
    • Physical examination:
    - Mass palpable with pulsatility
    - Auscultation
    • Plain Radiograph
    Calcification of the wall of aneurysm

    • Ultrasound / Doppler ultrasound


    Dilatation of artery
    DIAGNOSIS OF ANEURYSM

    • Conventional X-Ray
    Chest X-ray (PA view)
    Abnormality of contour
    and tortuosity of the
    aorta with calcifications
    within vessels wall.
    Dilatation of aneurysm
    DIAGNOSIS OF ANEUVRYSM
    Computed tomography angiogram
    Without IVC : Calcification & dilatation
    With IVC : Enhanced vessels to different from other structure neighbor.

    Axial
    3 D rec.
    plan IVC Axial IVC bony window
    Dilatation of artery
    Diagnosis of aneurysm

    • Angiography:
    Performs with
    contrast media
    under special type
    of fluoroscopy (C –
    arm type)
    Dilatation of artery
    Diagnosis of aneurysm

    • CTA and AMRI


    - Increased diameter of
    artery size.
    - Mural thrombus
    - Calcifications
    - Luminal patency
    - Mass effect

    CTA : Aneurysm of ascending


    aorta

    MRA : Aneurysm of ascending aorta


    Dilatation of artery
    Diagnosis of aneurysm
    Inflammatory aneurysm

    - due to fibrosis occurs in


    the wall of artery.
    - MRA and FDG-PET are
    unreliable (new research
    in 2008)

    Inflammatory aneurysm of
    abdominal aorta (CTA
    reconstruction 3D)
    Dissection arteries
    CAROTID ARTERY ANEURYSM

    Extra cranial
    aneurysm:
    Cause:

    - Trauma
    - Infection
    - Congenital (rare)

    Angiography

    Duplex ultrasound of
    Common Carotid Artery
    ICA ANEURYSM / PARIETAL
    THROMBOSIS

    DUPLEX ULTRASOUND

    ICA ANEURYSM / PARIETAL


    VESSELS THICKENING AND
    THROMBOSIS
    ICA ANEURYSM / PARIETAL
    THROMBOSIS

    Giant aneurysm in left ICA


    on nonenhanced CT scans

    MRI : T1 Weighted
    Giant mass surrounded by
    edema tissue
    ARTERIO-VENOUS FISTULA
    STENOSIS OF CAROTID ARTERY

    External carotid artery


    stenosis:
    PS increased 426 .7 cm /s
    ED 25 cm/s

    Internal carotid artery with


    high resistant (blood supply
    decreased).,
    Elderly patient : vertigo
    INTERNAL CAROTID ARTERY STENOSIS

    STRING SIGN

    ANGIO-CT INTERNAL
    CAROTID ARTERY
    STENOSIS.

    STENOSIS INTERNAL
    CAROTID ARTERY
    (on CE-MRA)
    Cause of stenosis carotid artery
    ULCERATED PLAQUE OR TWINKLE
    ARTIFACT (ICA)

    Tahmasebpour HR et al. Radiographics 2005; 25 : 1561-1575


    VERTEBRAL ARTERY STENOSIS
    Symptom sign of VS :

    - Vertigo
    - Ataxia
    - Loss of balance

    Diagnostic based to
    - Duplex
    - ACT
    - MRA
    VERTEBRAL ARTERY STENOSIS
    THORAX & ABDOMEN
    VESSELS
    BRIEF ANATOMY OF VASCULAR
    (THORAX & ABDOMEN)
    BRIEF ANATOMY OF VASCULAR
    (THORAX & ABDOMEN)
    Congenital anomalies
    Left arc / aberrant right subclavian artery
    Most common arc
    anomaly.
    1% found individual
    Arise from 4th branch of
    the arc and cross
    mediastinum to reach
    right arm.

    AMRI and CTA


    - Dilatation (higher than
    normal aorta arc).
    - Can associated with
    congenital heart
    disease about 10 % of
    these cases
    ANGIO-MRI

    AORTIC ARC :

    - RCCA : right common carotid a.


    - RSCA : right subclavian a.
    - RVA : right vertebral artery
    - LVA : left vertebral a.
    - LSCA : left subclavian a.
    GREAT VESSELS
    GREAT VESSELS : AORTA
    Aorta aneurysm
    • USG
    . Most secondary to
    degenerative & arterosclerosis
    disease of the tunica media
    . True aneurysm :all layers are
    False aneuvrysm
    included
    . False aneurysm : not all layers
    are include usually just adventitia

    True aneurysm
    GREAT VESSELS : AORTA
    Thoracic aortic aneurysm
    • Aortography
    Actual: not diagnostic, replaced
    by ACT but treatment (stent)
    • CHEST X-Ray:
    Dilated & tortuous aorta with
    calcification.
    • Angio- Computed Tomography
    AORTIC DISSECTION
    Spontaneous longitudinal separation of
    aortic intima and adventitia by circulating
    blood having gained access to media of the
    aortic wall splitting it in two.
    (Intima tear).
    CXR :
    Calcification (compare with previous
    X- Ray)
    USG :
    - Intima Flap Real time
    - Double barrel
    AORTIC DISSECTION

    MRI :
    - Intimal flip (SE image)

    AMRI : SE : The entry sites is visualized as focal


    interruption of the linear image of the intima flap
    STENOSIS OF ARTERY

    Angiography of left subclavian


    artery:

    Stenosis
    ABDOMINAL VESSELS
    BRIEF ANATOMY OF ABDOMEN
    PORTAL VEIN PATHOLOGY
    • Thrombosis portal vein

    • Artero-portal fistula

    • Portal vein aneurysm


    ABDOMINAL AORTA ANEURYSM
    Angiography of abdominal aorta & USG

    Focal dilatation of just above


    0.5 cm at level bifurcation CIA.
    Focal widening > 3 cm
    Frequent man > woman
    60 %
    Cause:
    . Aorta dissection
    . Arteerosclerosis
    . Traumatic
    . Congenital
    . Syphilis
    . Mycotic (infection)
    . Aortitis
    . Increased pressure (HBP, stenosis valve)
    AORTIC DISSECTION
    CECT :
    - Crescentic high –attenuation clot
    within false lumen.
    - displaced intima calcification
    - Intima flap separating two aortic
    channels.
    RENAL ARTERY
    Renal artery normal
    INVESTIGATION RENAL ARTERY THROUGH
    ECHO-DOPPLER

    INVESTIGATION SEGMENTAL ARTERY


    (Power doppler)
    STENOSIS VESSEL INTRA-ABDOMEN

    Bilateral renal arteries stenosis


    (angiography)

    Right renal artery stenosis


    (CT –angiography )
    STENOSIS VESSELS INTRA-ABDOMEN
    STENOSIS OF ARTERY

    Left renal artery :


    Stenosis
    junction aorta
    VASCULAR ANATOMY OF LIMBS
    UPPER LIMB
    ANEURYSM

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