Disease of Aorta and Trauma to The Aorta

and Heart
Rido Maulana
Rudini

Resource person : dr. Suko Adiarto, PhD, Sp.JP (K)

Outline
• Introduction
• Anatomy of the aorta
• Histology of the aorta
• Assessment of the aorta
• Treatment options
• Acute aortic syndromes (aortic dissection)
• Aortic aneurysm
• Heart and aortic trauma
 Introduction
• Aortic diseases may have acute presentation (as a in acute aortic
syndrome) or a long period of subclinical development (as in
atherosclerotic and inflammatory affection)
• Global death rate of aortic aneurysm & aortic dissection: 2.78/100.000
inhabitants in 2010

• Higher prevalence in older age

• Men > women
Anatomy of the Aorta
 Histology of the aorta

• Tunika intima : thin inner lined by

the endothelium
• Tunika media : elastic and collagen
fibres, as smooth muscle
• Tunika adventitia : mainly
collagen, vasa vasorum, and
lymphatics
 Assessment of the aorta
◦ Assessment of medical history should focus on:
◦ optimal understanding of patients complaints,
◦ personal cardiovascular risk factors,
◦ family history of arterial diseases (especially aneurysms, aortic dissection, or
sudden death).

◦ Physical Examination:
◦ Directed by the symptoms
◦ Palpation and auscultation of the abdomen and flank in search for prominent
arterial pulsations or turbulent blood flow causing murmur
 Assessment of the aorta
• Symptoms may be related to different aortic diseases:
• Acute deep, aching or throbbing chest or abdominal pain (best described as
‘feeling of rupture’) that can spread to the back, buttocks, groin or legs, 
AD or other AAS.
• Cough, shortness of breath, or difficult or painful swallowing  large TAAs.
• Constant or intermittent abdominal pain or discomfort, a pulsating feeling in
the abdomen, or feeling of fullness after minimal food intake  large AAAs.
• Stroke, transient ischaemic attack, or claudication secondary to aortic
atherosclerosis.
• Hoarseness  left laryngeal nerve palsy in rapidly progressing lesions.
 Assessment of the aorta

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal (2014) 35, 2873–2926
doi:10.1093/eurheartj/ehu281
 Classification of Aortic Diseases
Aortic Diseases

Acute Aortic Genetic Diseases Atherosclerotic

Aortic Aneurysms Aortitis Aortic Tumors Infection
Syndromes Affecting The Aorta Lesions

Acute Aortic Chromosomal and

Thoracic AA Thromboembolic Giant Cell Arteritis Infection in AA
Dissection inherited syndromic
TAA-D

Intramural Mobile Aortic

Abdominal AA Takayasu Arteritis Graft Infection
Haematoma Thrombosis
Bicuspid Aortic Valve

Penetrating Aortic Atherosclerotic

Ulcer Coarctation of The Aortic Occlusion
Aorta

Aortic
Calcified Aorta
Pseudoaneurysm

Traumatic Aortic
Coral Reef Aorta
Injury

Iatrogenic Aortic
Dissection
Treatment Option
Acute Aortic Syndrome
 Acute Aortic Syndromes
Definition
a constellation of life-threatening conditions which share common
pathophysiological pathways involving the aorta.
AAS occur when:
a tear or an ulcer allows blood to penetrate from aortic lumen into
the media,
a rupture of vasa vasorum causes a bleed within the media.
 Acute Aortic Dissection

Traumatic Aortic Injury

Aortic Intramural Hematom

Acute Aortic
Syndrome
Penetrating Aortic Ulcer

Aortic Pseudoaneurysm

Iatrogenic Aortic Dissection

 Classification of AAS in Aortic
Dissection
Class 1: Classic AD with true and FL
with or without communication between
the two lumina.
Class 2: Intramural haematoma.
Class 3: Subtle or discrete AD with
bulging of the aortic wall.
Class 4: Ulceration of aortic plaque
following plaque rupture.
◦ Class 5: Iatrogenic or traumatic AD,
illustrated by a catheter-induced
separation of the intima.
 1. Acute Aortic Dissection
• Definition: disruption of the medial layer separation of aortic
wall layers  formation of a true lumen & a false lumen with or
without communication.
• In most cases, intimal tear as the initiating condition  tracking
of the blood in a dissection plane within the media.
• Epidemology: in U.S.A 6 cases/100.000/year, men>women
• Autopsy study: found in 20% of fatal road accident
1. Acute Aortic Dissection
Classification of AD Localization
 Aortic Dissection –
Chest Radiograph

Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 10th Edition. 2015.
Aortic Dissection on TTE

Echocardiography in
aortic diseases: EAE
recommendations for
clinical practice.
European Journal of
Echocardiography (2010)
11, 645–658
doi:10.1093/ejechocard/jeq
056
Aortic Dissection on TEE

Echocardiography in aortic
diseases: EAE recommendations
for clinical practice. European Journal
of Echocardiography (2010) 11, 645–658
doi:10.1093/ejechocard/jeq056
Aortic Dissection – Contrast CT-scan

Duran, E.S., et al. Computed

Tomography Imaging Findings of
Acute Aortic Pathologies. Cureus.
2019 Aug; 11(8): e5534.
Aortic Dissection – Contrast CT-scan

Duran, E.S., et al. Computed

Tomography Imaging Findings of
Acute Aortic Pathologies. Cureus.
2019 Aug; 11(8): e5534.
 Treatment
• Type A Aortic Dissection
Surgical • Retrograde Dissection Into The Ascending Aorta

• Complicated Type B Aortic Dissection

• Persistent/recurrent pain
• Uncontrolled hypertension
Endovascular • Early aortic expansion
• Malperfusion
• Signs of rupture (haemothorax, ↑periaortic & mediastinal
haematoma)

Medical: • Uncomplicated Type B Aortic Dissection

Pain relief, HR control, • Uncomplicated Isolated Arch Dissection
BP control
II. Intramural Haematoma
Definition: haematoma within the
aortic wall in the absence of a false
lumen and intimal tear.

Diagnosis: presence of
circular/crescent shaped thickening
>5mm of the aortic wall without
detectable blood flow  10-25%
AAS
 Treatment

Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
III. Penetrating Aortic Ulcer
Definition: ulceration of an aortic
atherosclerotic plaque penetrating through the
internal elastic lamina to the media  further
causing IMH, pseudoaneurysms, aortic rupture.

Common location: middle and lower

descending aorta.

Common feature: older age, male, tobacco

smoker, hypertension, CAD, COPD, AAA
 Treatment

Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
OV
ER
ALL
Trauma To The Aorta
and Heart
 Trauma to the Aorta
Aortic Injury  life threatening conditions  second most common cause of
death in blunt force trauma patients  80% patients die at the scene (15% of
all death e.c. motor vehicle collisions).
Predisposing conditions: penetrating chest injuries, deceleration injuries, blunt
chest trauma.
Most common injury sites:
• Aortic isthmus
• Distal to the origin of left subclavian artery
• Tethered site of the aorta at ligamentum arteriosum
• Ascending aorta, proximal to the origin of brachiocephalic vessels
 Major Mechanisms
• Rapid acceleration and deceleration  head-on collisions or lateral impact.
• Significant falls (>4 meters)  blunt force compression of chest wall contents.
• Twisting against fixation points.
• Seatbelt injuries.
• Other high risk mechanisms: ejection of an unrestrained passanger from
vehicle, severe injuries resulting in death at the scene of accident.
• Rupture of the adventitia  lethal internal hemorrhage.
Otte, Dietmar & Facius, Thorsten & Brand, Stephan. (2017). Injury Mechanisms of Aortic
Ruptures to Vehicle Occupants and Vulnerable Road Users – An In-Depth-Investigation over
Time. Journal of Forensic Biomechanics. 08. 10.4172/2090-2697.1000132.
 Type of Injury
Intimal tear
Rupture of the adventitia.
Mediastinal hematoma
Usually develops secondary to trauma.
Transection of the aorta
Complete rupture of the aorta (including
adventitial layer & periadventitial connective
tissue)  immediate exsanguination.

Beware of delayed adventitial rupture during

hospitalization!
 Aortic Injury Grading

Mokrane, F.Z., et al. Traumatic injuries of the thoracic aorta: The role of imaging in diagnosis and treatment. Diagnostic and Interventional Imaging. Volume 96, Issues 7-8, July-August 2015: 693-706. Elsevier.
Chest Radiograph
Low sensitivity
Non diagnostic findings:
• Widening of mediastinum
• Loss of aortic knob normal shadow
• Left apical pleural cap or fluid, or
blood
• Left pleural effusion
• Deviation/displacement of the
trache, or esophagus to the right
 CT Angiography
Investigational modality of use.
Findings:
Mediastinal hematoma:
Abnormal soft tissue density around mediastinal structures.
Periaortic hematoma.
Aortic injury:
Intraluminal filling defect due to intimal flap or clot.
Abnormal aortic contour due to mural hematoma.
Pseudoaneurysm formation: tear in muscularis layer  susceptible to
rupture.
Extravasation of contrast  active hemorrhage.
Diagnostic
Algorithm
 Treatment
Assessment of associated injuries:
Rapid identification and control ongoing hemorrhage.
Monitoring and control the heart rate and blood pressure.
Avoiding over resuscitation.
Indications for operative repair:
Unstable patient.
Large amount of blood return from chest tube (>200 ml).
 Surgical
Contrast extravasation on CT scan.
Rapidly expanding mediastinal hematoma.
Emergency
Penetrating aortic injury.
Hemorrhage control is the priority!
 Cardiac Trauma
Direct impact to the anterior chest

Blunt High speed sudden deceleration

• Most often: male, Compression of the chest

Method of 30s y.o.; 7 y.o.
injury • 30% incidence of
electrical abnormalities Stab wounds

Penetrating Gunshot wounds

• Any age and gender Non firearms blast injuries

• Most frequently injured:
RV > LV > atria/multiple
chambers
 AAST Cardiac Injury Scale
Grade I
1.Blunt cardiac injury with minor EKG abnormality (non specific ST of T wave changes, premature atrial or ventricular contractions, or persistent sinus
tachycardia
2.Blunt or penetrating pericardial wound without cardiac injury, tamponade, or cardiac herniation
Grade II
1.Blunt cardiac injury with heart block or ischemic changes without cardiac failure
2.Penetrating tangential cardiac wound, up to but not extending through endocardium, without tamponade
Grade III
1.Blunt cardiac injury with sustained or multifocal ventricular contracations
2.Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid incompetence, papillary muscle dysfunction, or distal coronary artery
occlusion without cardiac failure
3.Blunt pericardial laceration with cardiac herniation
4.Blunt cardiac injury with cardiac failure
5.Penetrating tangential myocardial wound, up to but not through endocardium, with tamponade
Grade IV
1.Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid incompetence, papillary muscle dysfunction, or distal coronary artery
occlusion producing cardiac failure
2.Blunt or penetrating cardiac injury with aortic or mitral incompetence
3.Blunt or penetrating cardiac injury of the right ventricle, right or left atrium
Grade V
1.Blunt or penetrating cardiac injury with proximal coronary artery occlusion
2.Blunt or penetrating left ventricular perforation
3.Stellate injuries, less that 50% tissue loss of the right ventricle, right or left atrium
Grade IV
1.Blunt avulsion of the heart
2.Penetrating wound producing more than 50% tissue loss of a chamber
 Evaluation
General trauma evaluation:
• Physical examination
• ECG  presence of new dysrhythmias
• Chest radiograph  presence of foreign bodies, hemothorax, displaced heart,
non cardiac thoracic injuries.
• Point-of-care ultrasound (POCUS)/ Echocardiography --> pericardial
effusions/tamponade, IVC distension, septal bouncing, wall motion & valvular
abnormalities, great vessels structures.
• CT-scan & MRI  high sensitivity for pericardial or myocardial lacerations,
cardiac luxation, other injuries, identify foreign bodies  only used in stable
patients.
 Evaluation
• Obtaining an ECG in all patients with suspected BCI.
 Patients with abnormal findings → continuous cardiac monitoring (Normal ECG
does not entirely exclude BCI)
 Patients with a normal ECG in conjunction with normal levels of cTnI can be
safely discharged home.
 Furthermore, it should be noted that a normal ECG and cTnI levels do not rule
out all BCI as some may have a delayed presentation (e.g., septal injury).
• Patients with abnormal ECG and/or cTnI levels should be admitted for cardiac
monitoring for 24 to 48 hours because life-threatening arrhythmias or cardiac
failure will most likely present during this time.
 Management
• Routine ATLS care  airway, breathing, cervical spine protection.
• Treatment and monitoring for:
 Dysrhythmias
 Myocardial infarctions  beta blockers, cardioversion
 Damage to cardiac tissue: rupture, lacerations, penetrative  surgical
procedure
 Coronary artery lacerations or bleeding  surgical control, coronary bypass,
angiography (in non bleeding)
 Cardiac tamponade  pericardiocentesis
Aortic Aneurysms
 Definition
• An aneurysm is an abnormal localized dilatation of an artery
• The term aneurysm is applied when the diameter of a portion of the aorta has increased by at
least 50% compared with normal.
• A true aneurysm a dilatation of all three layers of the aorta, creating a large bulge of the
vessel wall (fusiform or saccular)
• Fusiform : symmetrical dilatation of the entire circumference of a segment of the
aorta
• Saccular : localized outpouching involving only a portion of the circumference
 Definition
• In contrast, pseudoaneurysms (“false” aneurysms), bleeding has occurred
through the aortic wall and resulted in a contained periaortic hematoma in
continuity with the aortic lumen. Pseudoaneurysms may result from trauma or
contained rupture of an aortic aneurysm, dissection, or penetrating ulcer.
Aortic Aneurysm
 Etiology and Patophysiology
• The etiology of aortic aneurysm formation varies depending on the location of the lesion
• Ascending thoracic aortic aneurysms typically are characterized by cystic medial
degeneration (also termed cystic medial necrosis), elastic fiber loss from the medial layer,
loss of vascular smooth muscle cells, and proteoglycan deposition.

Leonard S.Lilly. Patophysiology of

heart disease A Collaborative
Project of Medical Students and
Faculty, Sixth edition, International
Table 1. Conditions associated with true aneursyms, Edition. 2015
 Etiology and Patophysiology
• Aneurysms of the descending thoracic and abdominal aorta are usually
associated with atherosclerosis and its risk actors (smoking, hypertension,
dyslipidemia, male gender, and advanced age)
 Classification
Classification based on location:
• Abdominal Aortic Aneurysm (AAA), most frequent
• Thoracic Aortic Aneurysm (TAA)
• Thoracoabdominal Aortic Aneurysm (TAAA)

Histopathology
Involves medial degeneration (formerly called cystic medial necrosis),
characterized by elastic fiber loss from the medial layer, loss of vascular
smooth muscle cells, and proteoglycan deposition.
Presence of AA  possible other locations of aneurysms (Illiac, popliteal,
femoral).
Braverman AC. Diseases of the
aorta. In: Braunwald’s Heart
Disease. 11th Edition. 2019.
 Clinical Presentation
• Most aneurysms are asymptomatic  until it expand or rupture
• Especially those with abdominal aortic aneurysms, may be aware of a pulsatile
mass
• Thoracic aortic aneurysms may compress the trachea or mainstem bronchus,
resulting in cough, dyspnea, or pneumonia.
• Compression o the esophagus can result in dysphagia, and involvement o the
recur- rent laryngeal nerve may lead to hoarseness
• Aneurysms of the ascending aorta may dilate the aortic ring, resulting in aortic
regurgitation and symptoms o congestive heart failure.
• Abdominal aortic aneurysms may cause abdominal or back pain or nonspecific
gastrointestinal symptoms.
 Abdominal Aortic Aneurysm
• Definition : Abdominal aorta greater than 3 cm in diameter
• Main etiology : degenerative; frequently associated with atherosclerotic
disease.
• Risk factors:
Male, older age, history of atherosclerotic disease, smoking, former
smokers, hypertension, hyperlipidemia, family history, emphysema
• Location: 80% infrarenal, 10% pararenal/visceral, some extended to
thoracoabdominal segment.
• Natural History : Large and life-threatening AAA is preceded by long
period of subclinical growth in the diameter, estimated (<1-6 mm/year),
the risk of rupture with maximal diameter higher in women than in men
 Abdominal Aortic Aneurysm
• Pathophysiology:
AAA formation is associated with chronic wall inflammation,
increased local expression of proteinases, and degradation of
structural connective tissue proteins.
Abdominal Aortic Aneurysm

Braverman AC. Diseases of the

aorta. In: Braunwald’s Heart
Disease. 11th Edition. 2019.
Braverman AC. Diseases of the
aorta. In: Braunwald’s Heart
Disease. 11th Edition. 2019.
Eur Heart J, Volume 35, Issue 41, 1
November 2014, Pages 2902,
https://doi.org/10.1093/eurheartj/ehu281
 Abdominal Aortic Aneurysm
• Clinical Features AAAs
- Develop insidiously over several years, rarely cause symptoms in the
absence of distal thromboembolism, rapid expansion, or rupture.
- Most AAAs are detected by screening studies or as an incidental finding on
imaging studies performed for another purpose.
- Atypical abdominal or back pain may be present
- Physical examination is insensitive in detecting AAAs, but abdominal
palpation may reveal a pulsatile epigastric or periumbilical mass.
- Only 30% to 40% of AAAs are noted on physical examination
Diagnostic Imaging
• Abdominal ultrasound (US) can detect AAAs with high accuracy and is preferred
over CT in screening for AAAs because US is inexpensive, noninvasive, and avoids
radiation and contrast agents .
• CT and MRI  current gold standard in the pre-operative and post-operative
evaluation of AAAs.
Diagnostic Imaging

Eur Heart J, Volume 35, Issue 41, 1

November 2014, Pages 2873–2926,
https://doi.org/10.1093/eurheartj/ehu281
Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
 Thoracic Aortic Aneurysms
• Etiologies : Most common degenerative aneurysm
• Incidence : at least 5-10/100.000 person-year
• Location:
• Ascending/aortic root aneurysms (±60%)
• Descending thoracic aneurysms or thoracoabdominal aneurysms (±35%)
• Aortic arch aneurysms (<10%)

• Natural history:
• Familial TAAs grow faster  up to 2.1mm/year
• Descending TAAs grow faster (3mm/year) than ascending TAAs (1mm/year)
• Rapidly increased risk of dissection/rupture when Ao diameter >60mm for
ascending Ao and >70mm for descending Ao.
 Thoracic Aortic Aneurysms
Causes
• Heritable disorder
• Genetic
• Congenital disorder
• Degenerative
• Inflamatory
• Infectious disease
 Thoracic Aortic Aneurysm

Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 10th Edition. 2015.
Braverman AC. Diseases of the
aorta. In: Braunwald’s Heart
Disease. 11th Edition. 2019.
 Thoracic Aortic Aneurysm - Imaging

Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 11th Edition. 2015.
 Thoracic Aortic Aneurysm - Imaging

Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 11th Edition. 2019.
 Risk of Complications, Specifically Aortic Rupture,
Dissection, and Death, Increases With Increased Aneurysm
Size

Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 11th Edition. 2019.
Braverman AC. Diseases of the aorta. In: Braunwald’s Heart Disease. 11th Edition. 2019.
Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
Genetic Diseases Affecting The Aorta
 Definition
• Genetic diseases affecting the aorta are broadly split into two categories: syndromic and non-
syndromic  both essentially displaying autosomal dominant transmission
• Both categories and chromosomal or molecular entities of inherited TAAD, as well as non-
inherited thoracic aortic aneurysms and dissection (TAAD)  display cystic medial necrosis
I. Chromosomal and Inherited Syndromic Diseases
I. Chromosomal and Inherited Syndromic Diseases
Eur Heart J, Volume 35, Issue 41, 1 November 2014, Pages 2873–2926, https://doi.org/10.1093/eurheartj/ehu281
 Coarctation of The Aorta
• Definition : Considered to be a complex disease of the vasculature and not only as a
circumscript narrowing of the aorta. Occurs as a discrete stenosis or as a long,
hypoplastic aortic segment.
• Location: area of ductus arteriosus insertion. occures ectopically (ascending, descending,
or abdominal aorta) in rare cases
• Incidence : about 5-8% of all congenital heart defect, the prevalence of isolated forms is 3
per 10.000 live births.
• Diagnostic work-up
Clinical Features
• Upper body systolic hypertension, lower body hypotension  a blood pressure gradient
between upper and lower extremities (>20mmHg indicates significant coarctation of the
aorta).
• Radiofemoral pulse delay.
• Palpable collaterals.
 Coarctation of The Aorta
• Diagnostic work-up
Echocardiography
• Provides information regarding site, structure, and extent of CoA, Left ventricular
function and hypertrophy, cardiac abnormalities, and aortic and supra-aortic vessel
diameters.
Doppler gradients
• Are not useful for quantification, neither in native nor in post-operative CoA
MRI and CT
• Preferred non-invasive technique to evaluate the entire aorta in adults, (both depict site,
extent, and degree of the aortic narrowing, the aortic arch, the pre- and post-stenotic
aorta and collaterals
Angiography
• Gold standard for evaluation before and after operative or interventional treatment
 Coarctation of The Aorta

Cangussu, L.R., et al. The importance of the early diagnosis of aorta coarctation. Rev. Assoc. Med. Bras. vol.65 no.2 São Paulo Feb. 2019.
https://doi.org/10.1590/1806-9282.65.2.240 
 Bicuspid Aortic Valve
• Prevalence : BAV is the most common congenital cardiac defect with a
prevalence 1-2% at birth. Male are often than Female (ratio ranging from 2: 1
to 4:1).
• Types : BAV is the result of fusion of the left coronary cusp (LCC) and right
coronary cusp (RCC) > 70 % patients, fusion of the RCC + NCC in 10-20%
patients, fusion of LCC + NCC in 5-10% patients. True bicuspid valves and
unicommisural valves  very rare
• Patients with BAV may be completely asymptomatic  30% individuals
develop clinical manifestations: dysfunction of aortic valve (stenosis of
insufficiency), artopathy (dissection), and endocarditis.
Bicuspid Aortic Valve

J. Cardiovasc. Dev. Dis. 2015, 2(4), 248 272; https://doi.org/10.3390/jcdd2040248

Bicuspid Aortic Valve
I. Bicuspid Aortic Valve
Atherosclerotic Lesions of
The Aorta
 Atherosclerotic lesions of the aorta
• Thromboembolic Aortic Disease
• Accumulation of lipids in the intima-media layer of aorta
• Mobile Aortic Thrombosis
• Mobile thrombi in the aorta of young patients without diffuse atherosclerosis have been
reported
• Atherosclerotic Aortic Occlusion
• Abdominal aortic occlusion is rare and results in a major threat of leg amputation or death.
• Calcified Aorta
• Calcification occurs in the media, and the amount of calcification is directly associated with the
extent of atherosclerosis.
• Coral Reef Aorta
• Is described as rock –hard calcifications in the visceral part of the aorta. These heavily calcified
plaques grow into the lumen and can cause significant stenosis
Aortitis
 Aortitis
• Definition : General term used to define Inflammation of the aortic wall.
• Etiology:
• Non-infectious inflammatory vasculitis: giant cell arteritis & Takayasu arteritis 
most common.
• Other inflammatory conditions: Becer’s disease, Buerger disease, Kawasaki
disease, ankylosing spondyloarthritis, Reiter’s syndrome.
• Infections due to: Staphylococcus, Salmonella, mycobacteria  less common.
• Treatment:
• Non-infectious: corticosteroids  predisone; methotrexate, azathioprine, anti-
tumour necrosis factor-alpha agents.
• Suspected infection: broad spectrum intravenous antibiotics.
 Aortitis - Imaging

Takayasu arteritis in a 22-year-old woman. Contrast material–
enhanced CT image shows extensive thickening of the aortic wall
that involves the entire thoracic aorta (arrows). There is an area
of ulceration in the anteromedial wall of the descending aorta
(arrowhead).
GCA in a 72-year-old woman. Contrast-enhanced CT image shows
diffuse abnormal thickening of the thoracic aorta. The thickening was due
to an extensive intramural hematoma.

Restrepo CS. Published Online: March 07, 2011

https://doi.org/10.1148/rg.312105069
THANK YOU
Reference
• Man DL, Zipes, et.al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2-
Volume Set 11th Edition. Elsevier (Philadelpia).2019