E2636. Imaging of Acute Aortic Syndrome: A Primer For Trainees
  1. Amr Wadeh; SUNY Upstate Medical University
  2. Hatem Al Kashroom; SUNY Upstate Medical University
  3. Michael Mellace; SUNY Upstate Medical University
  4. Leen Alkukhun; SUNY Upstate Medical University
  5. Ernest Scalzetti; SUNY Upstate Medical University
Acute aortic syndrome encompasses several potentially life-threatening pathologies including acute aortic dissection (AAD), intramural hematoma (IMH), limited intimal tear (LIT), penetrating atherosclerotic ulcer (PAU), traumatic or iatrogenic aortic dissection, and leaking or ruptured aortic aneurysm. It is important to distinguish among all the different entities as management and prognosis can vary between the distinct types. It is also essential to diagnose and report complications associated with the acute aortic syndrome in the acute, subacute, or chronic phase. Complications can be a secondary sign to detect the types and locations of different subtypes of aortic syndromes, especially for trainees who have not encountered the many different types of aortic syndromes.

Educational Goals / Teaching Points
Differentiate between all the different entities of acute aortic syndrome. Distinguish and efficiently report the involvement of the ascending aorta (lesion type), location and size of the initiating intimal tear, rupture, end-organ damage, size and patency of the false lumen, as well as presence of clot, complexity, and extent of the dissection. Familiarize the residents with the Stanford classification system, its limitations, and importance in diagnosis and management. Utilize the different image modalities (CT and MRI) and pre and post contrast images to differentiate between acute aortic dissection, intramural hematoma, and intimal tear.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A CTA of the thorax shows the different types of acute aortic syndromes with diagrammatic representations highlighting the underlying pathologies.

It is important for trainees to diagnose, interpret, and clearly report cases of acute aortic syndrome. It is also vital to know the distinct types of acute aortic syndrome, their prognosis, and appropriate management.