E1225. The Road Well Less Traveled: Looking Beyond the Acute Aortic Syndromes
  1. Mark Manganaro; University of Rochester
  2. MariaClara Lorca; University of Rochester
  3. Jay Im; University of Rochester
  4. Abishek Chaturvedi; University of Rochester
Acute aortic syndromes include: intramural hematoma, penetrating atherosclerotic ulcer, limited intimal tear, traumatic or iatrogenic aortic dissection, and leaking or ruptured aortic aneurysm. Radiologic imaging has the ability to confirm or exclude these life-threatening acute aortic entities and delineate them from other aortic pathologies. In this exhibit, we aim to shed more light on these less frequently seen acute aortic pathologies and diagnoses beyond the aforementioned acute aortic syndromes.

Educational Goals / Teaching Points
Briefly discuss the acute aortic syndromes so the reader has baseline knowledge. Case based review of various pathologic and iatrogenic entities involving the aorta excluding the acute aortic syndromes. When applicable, differentiate between some acute aortic syndromes and the less common aortic pathologies that appear similar radiologically such as an aortic web and an aortic dissection or streak artifact, etc. Differentiate between intraluminal/intrinsic, interstitial/wall, and extraluminal/extrinsic causes of aortic pathologies. Correlate CT findings with appearances on other modalities, such as plain radiography, MRI, and fluoroscopy. When applicable, present pathologic correlations with these entities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will briefly discuss the anatomy of the aorta and subsequently highlight some entities involving different aspects of the aorta. Some of these entities include, but are not limited to intraluminal aortic foreign bodies (arterial placement of central lines, an embolized aortic valve/mitral clip/ASD occluder device, complications associated with aortic devices), intraluminal thrombus and mimics (stasis thrombus, free floating thrombus, aortic web), aortic wall diseases (Erdheim Chester disease, aortitis, aortic intimal sarcoma, aortic metastasis), extraluminal aortic diseases (aortoenteric fistulas - aortoesophageal, aortogastric, etc., mediastinal masses - lung cancer, thymic cancer, etc., pseudoaneurysm due to postoperative suture dehiscence, penetrating injury, displaced sternal wires).

Most radiologists are familiar with common entities that make up acute aortic syndromes; however, most are not as familiar with the other aortic pathologies and diagnoses that can arise. Being able to radiologically differentiate and diagnose these entities guides management and is a crucial part to prevent future morbidity and mortality for these patients.