Eighteen cases of dissecting aneurysm of the aorta are presented to illustrate the factors predisposing to this process. These factors, which include hypertension, arteriosclerosis, trauma, cardiovascular lesions, connective tissue diseases, inflammation, and pregnancy, cause disrup tion of the media of the aortic wall through abnormal hemodynamics, in herent defects in the aortic wall, or insult to a normal aortic wall. There was a close correlation between the predisposing factor and the type of dis section (ascending, descending, or dissection of the entire aorta). Distinc tive radiographic and angiographic features of some of these predisposing factors are reviewed to aid the radiologist in the diagnosis.
Get full access to this article
View all access options for this article.
References
1.
Stein, H.L., Steinberg, I.: Selective aortography, the definitive technique, for diagnosis of dissecting aneurysm of the aorta. Am. J. Roentgenol. Radium Ther. Nucl. Med., 102: 333-348, 1968.
2.
Hayashi, K., Meaney, T.F., Zelch, J.V., et al.: Aortographic analysis of aortic dissection. Am. J. Roentgenol. Radium Ther. Nucl. Med., 122: 769-782, 1974.
3.
Kronzon, I., Deutsch, P.G., Lefleur, R., et al.: Diagnosis of dissecting aortic aneurysm by left atrial angiography . Am. J. Roentgenol. Radium Ther. Nucl. Med., 124: 458-460, 1975.
4.
Dinsmore, R.E. , Willerson, J.T., Buckley, M.J.: Dissecting aneurysm of the aorta. Aortographic features affecting prognosis. Radiology, 105: 567-572, 1972.
5.
McFarland, J. , Willerson, J.T., Dinsmore, R.E., et al.: The medical treatment of dissecting aortic aneurysms. N. Engl. J. Med., 268: 115-119, 1972.
6.
Nanda, N.C., Gramiak, R., Shah, P.M.: Diagnosis of aortic root dissection by echocardiography. Circulation, 48: 506-513, 1973.
7.
DeBakey, M.E. , Henly, W.S., Cooley, D.A., et al.: Surgical management of dissecting aneurysms of the aorta. J. Thorac. Cardiovasc. Surg., 49: 130-149, 1965.
8.
Gore, I., Hirst, A.E., Jr.: Dissecting aneurysm of the aorta. Prog. Cardiovasc. Dis. , 16: 103-111, 1973.
9.
Hirst, A.E., Jr., Johns, V.J., Jr., Kime, S.W., Jr.: Dissecting aneurysm of the aorta: A review of 505 cases. Medicine, 37: 217-257, 1958.
10.
Gore, I.: Pathogenesis of dissecting aneurysm of the aorta. Arch. Pathol. , 53: 142-153, 1952.
11.
Dow, J., Robach, E.J., Cole, F.: Dissecting aneurysms of the aorta. Br. J. Radiol., 39: 915-927, 1966.
12.
Lodwick, G.S. : Dissecting aneurysms of the thoracic and abdominal aorta. Report of six cases, with a discussion of roentgenologic findings and pathologic changes. Am. J. Roentgenol. Radium Ther. Nucl. Med., 69: 907-925, 1953.
13.
Gore, I.: Dissecting aneurysms of the aorta in persons under 40 years of age. Arch. Pathol., 55: 1-13, 1953.
14.
Meehan, J.J. , Pastor, B.H., Toore, A.V.: Dissecting aneurysm of the aorta secondary to tuberculous aortitis. Circulation, 16: 615-620, 1957.
15.
Harris, M.Dissecting aneurysm of the aorta due to giant cell arteritis. Br. Heart J., 30: 840-844, 1968.
16.
Mandel, W., Evans, E.W., Walford, R.L.: Dissecting aneurysm of the aorta during pregnancy. N. Engl. J. Med., 251: 1059-1061, 1954.
17.
Mayers, C.P. : Aortic aneurysm following external cardiac massage. Br. J. Surg., 59: 238-239, 1972.
18.
Braunwald, E., Gorlin, R., McIntosh, H.D., et al.: Cooperative study on cardiac catheterization . Circulation, 37-38: 93-100, 1968 (Suppl. 3).
19.
Strauss, R.G. , McAdams, A.J.: Dissecting aneurysm in childhood. J. Pediatr., 76: 578-584, 1970.
Kay, J.H., Dykstra, P.C., Tsuiji, H.K.: Retrograde ilioaortic dissection. A complication of common femoral artery perfusion during open-heart surgery. Am. J. Surg., 111: 464-468, 1966.
27.
Williams, C.D. , Suwansirikul, S., Engelman, R.M.: Thoracic aortic dissection following cannulation for perfusion. Ann. Thorac. Surg., 18: 300-304, 1974.
28.
Black, L.L. , McComb, R.J., Silver, M.D.: Vascular injury following heart valve replacement . Ann. Thorac. Surg., 16: 19-29, 1973.
29.
White, C.W. , Zoller, R.P.: Left aortic dissection following repair of coarctation of the aorta. The contribution of abnormal hemodynamics to medial degeneration. Chest, 63: 573-577, 1973.
30.
Robinson, G. , Siegelman, S., Attai, L.: Recurrent dissecting aneurysm of the aorta . N.Y. State J. Med., 72: 2328-2331, 1972 .
31.
Salama, F.D. , Blesovsky, A.: Complications of cannulation of the ascending aorta for open-heart surgery. Thorax, 25: 604-607, 1970.
32.
Kimbiris, D. , Dreifus, L.S., Adam, A., et al.: Dissection and rupture of the ascending aorta: Unusual complications of aortocoronary bypass surgery. Chest, 68: 313-316, 1975.
33.
Dunkman, W.B. , Leinbach, R.C., Buckley, M.J., et al.: Clinical and hemodynamic results of intraaortic balloon pumping and surgery for cardiogenic shock. Circulation, 46: 465-477, 1972.
34.
Lang, E.K.: A survey of the complications of percutaneous retrograde arteriography, Seldinger technique. Radiology, 81: 257-263, 1963.
35.
Wellons, H.A. , Jr., Singh, R.: Acute dissecting aortic aneurysm resulting from retrograde brachial arterial catheterization. Successful operative intervention . Am. J. Cardiol., 33: 562-565, 1974.
36.
Templeton, J.Y. , III, Johnson, R.G., Griffith, J.R.: Dissecting aneurysm of the thoracic aorta as a complication of catheter aortography: Successful surgical treatment. J. Thorac. Cardiovasc. Surg., 40: 209-214, 1960.
37.
Braunstein, H.: Dissecting aneurysm of the carotid artery and aorta after carotid arteriography. Am. Heart J., 67: 545-549, 1964.
38.
Palmer, R.F. , Wheat, M.W., Jr. Treatment of dissecting aneurysms of the aorta. Ann. Thorac. Surg., 4: 38-52, 1967.
39.
Schnitker, M.A., Bayer, C.A.: Dissecting aneurysm of the aorta in young individuals, particularly in association with pregnancy. With report of a case. Ann. Intern. Med., 20: 486-511, 1944.
40.
Jeresaty, R.M. , Basu, S.K., Franco, J.: Dissecting aneurysm of the aorta in Turner's syndrome. J.A.M.A., 222: 574-576, 1972.
41.
McKusick, V.A. , Logue, R.B., Bahnson, H.T.: Association of aortic valvular disease and cystic medial necrosis of the ascending aorta. Report of four instances. Circulation, 16: 188-194, 1957.
42.
Schoolman, A., Kepes, J.J.: Bilateral spontaneous carotidcavernous fistulas in Ehlers-Danlos syndrome. Case report. J. Neurosurg. , 26: 82-86, 1967.
43.
Lynch, H.T. , Larsen, A.L., Wilson, R., et al.: Ehlers-Danlos syndrome and "congenital" arteriovenous fistulae. A clinicopathologic study of a family. J.A.M.A., 194: 1011-1014, 1965.
44.
Bean, W.H., Ponseti, I.V.: Dissecting aneurysm produced by diet. Circulation, 12: 185-192, 1955.
45.
Hainer, J.W. , Hamilton, G.W.: Aortic abnormalities in relapsing polychondritis. Report of a case with dissecting aneurysm of the aorta. N. Engl. J. Med., 2801166-1168,1969.
46.
James, A.E. , Jr., Eaton, S.B., Blazek, J.V., et al.: Roentgen findings in pseudoxanthoma elasticum. Am. J. Roentgenol. Radium Ther. Nucl. Med., 106: 642-647, 1969.
47.
Ponseti, I.V. , Baird, W.A.Scoliosis and dissecting aneurysm of the aorta in rats fed with Lathyrus odoratus seeds. Am. J. Pathol. , 28: 1059-1064, 1952.
48.
Gray, S.H., Aitken, L.: Late gross lesions in the aorta and pulmonary artery following rheumatic fever . Arch. Pathol., 8: 451-463, 1929.
49.
Miyawaki, J. : A case of chronic dissecting aneurysm due to Takayasu's arteritis associated with Cushing's syndrome. J. Jap. Soc. Intern. Med., 63: 163-168, 1974.
50.
Manalo-Estrella, P., Barker, A.E.: Histopathologic findings in human aortic media associated with pregnancy. A study of 16 cases. Arch. Pathol., 83: 336-341, 1967.
Kountz, W.B. , Hempelmann, L.H.: Chromatrophic degeneration and rupture of the aorta following thyroidectomy in cases of hypertension. Am. Heart J., 20: 599-610, 1940.
53.
Lawrence, J.H. , Zimmerman, H.M.: Pituitary basophilism. Report of a case . Arch. Intern. Med., 55: 745-759, 1935.
54.
Mayer, S., Jr.: Nephrocalcinosis and hypertension following hyperparathyroidism: Terminal dissecting aneurysm. Bull. Johns Hopkins Hosp., 68: 319-328, 1941.
55.
Case Records of the Massachusetts General Hospital #27022 . N. Engl. J. Med., 224: 77-79,1941.
56.
McGoon, R.M. , Spittell, J.A., Jr., McGoon, D.C.: The prognosis in aortic dissection (dissecting aortic hematoma or aneurysm). Circulation, 31: 665-669, 1965.
