central neck dissection
(2013) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. Pulsation artefact can mimic dissection, is very common and seen in up to 92% of non-gated CTA studies 8. Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection. Dissections involving the aortic root should ideally be assessed with ECG-gated CTA which nearly totally eliminates pulsation artefact. The CTA radiology report should include at least: Transesophageal echocardiography (TOE) has very high sensitivity and specificity for assessment of acute aortic dissection, but due to limited access and its invasive nature, it has largely been replaced by CTA (or MRA in some instances) 5. Thoracic aortic dissection and aneurysm: evaluation with nonenhanced true FISP MR angiography in less than 4 minutes. The true lumen is often smaller due to compression by the false lumen 22. AJR Am J Roentgenol. Gartland S, Sookur D, Lee H. Aortic dissection: an x ray sign. Specifically, Stanford type B dissection the false lumen may 23: The differential on chest x-ray is that of a dilated thoracic aorta. Displacement of atherosclerotic calcification into the lumen is also a frequently identified finding. Srichai MB, Lieber ML, Lytle BW, Kasper JM, White RD. Non-contrast CT may demonstrate only subtle findings; however, a high-density mural hematoma is often visible. Emerg Radiol. The Chest X-Ray: A Survival Guide. Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification (which dictates management). 6. Rogers AM, Hermann LK et al. The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is termed the false lumen. Angiography still is required for endoluminal repair. true FISP) may see MRI having a larger role to play in the acute diagnosis, particularly in patients with impaired renal function 4. AJR Am J Roentgenol. Sebastià C, Pallisa E, Quiroga S et-al. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. There have been efforts to construct a clinical decision rule stratify risk of acute aortic dissection and avoid over-investigation. Published eight times a year, Annals includes original research articles, basic science research, surgical notes and techniques, reviews and case reports. 10. 2002;223 (1): 270-4. Macura KJ, Corl FM, Fishman EK et-al. 18. Risks of angiography include general risks of angiography plus the risk of catheterizing the false lumen and causing aortic rupture. Approximately 60% of dissections involve the ascending aorta (Stanford A or DeBakey I and II) 5. Pereles FS, Mccarthy RM, Baskaran V et-al. (2015) Circulation journal : official journal of the Japanese Circulation Society. 12. Aortic dissection may sometimes be classified as communicating versus non-communicating 16,17. [online] Available at: https://www.gov.uk/drug-safety-update/systemic-and-inhaled-fluoroquinolones-small-increased-risk-of-aortic-aneurysm-and-dissection-advice-for-prescribing-in-high-risk-patients [Accessed 22 Jun. Published eight times a year, Annals includes original research articles, basic science research, surgical notes and techniques, reviews and case reports. 19 (1): 45-60. Contrast-enhanced CT (preferably CTA) gives excellent detail. AJR Am J Roentgenol. 20. Annals of Vascular Surgery provides solid, peer reviewed coverage of clinical and experimental work in vascular surgery. Annals of Vascular Surgery provides solid, peer reviewed coverage of clinical and experimental work in vascular surgery. Access to full text is limited to personal subscribers. 2005;184 (4): 1245-6. 4. Nazerian P, Mueller C et al. 2019]. 8. (2011) Circulation. 360: k678. 2007;24 (4): 310. Some cases of aortic dissection may result in rupture, causing collapse and often death. It arises from the upper border of the scapula. Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. Pleural effusions are commonly seen which increase in sie doing the acute phase of dissection 22. Distinguishing between the two is often straightforward, but in some instances, no clear continuation of one lumen with a normal artery can be identified. Findings include 1-3,5: An essential part of the assessment of aortic dissection is identifying the true lumen, as the placement of an endoluminal stent-graft in the false lumen can have dire consequences. 2012;19 (4): 309-15. 22. 2005;184 (4): 1225-30. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. This International journal, Journal of Clinical Neuroscience publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. Examples include 5: Interestingly, there is a reported seasonal pattern of disease, with great risk in winter and during morning hours 22. Case 7: Stanford type A with rupture into pericardium, Case 8: dissection confined to the infrarenal aorta, Case 10: Stanford type B dissecting aneurysm, Case 22: Stanford type A : background Marfan syndrome, Case 25: ruptured Stanford type A aortic dissection, aortic dissection detection risk score (ADD-RS), thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries, ciprofloxacin use (unclear if class effect for fluoroquinolone agents), fluoroquinolones seem to promote loss of extracellular matrix integrity, by several mechanisms, in the UK caution is now advised in using these agents in high-risk patients, acute: within 14 days of first symptom onset, chronic: more than 3 months from the initial onset of symptoms, inherited connective tissue disorders (pathogenesis: medial degeneration), widened mediastinum: > 8.0-8.8 cm at the level of the, inward displacement of atherosclerotic calcification (>1 cm from the aortic margin), left main bronchus inferiorly (decreased angle from the horizontal), increased thickness of the left and/or right paratracheal stripe, an atypical variant that may be seen is an, imaging features of any of the complications of aortic dissection (see below), often compressed by the higher pressure false lumen and the smaller of the two, has outer wall calcifications (helpful in acute dissections), the origins of the celiac trunk, SMA and right renal artery usually arise from the true lumen, often larger lumen size due to higher false luminal pressures (but size can be influenced by phase of the cardiac cycle), often of lower contrast density due to delayed opacification, at risk for rupture due to reduced elastic recoil and dilation, right anterolateral aspect of the ascending aorta, left posterolateral aspect of the descending aorta, maybe thrombosed and seen as mural low density only (more common in chronic dissections), the left renal artery usually arises from the false lumen, surrounds the true lumen in Stanford type A, aortic size (largest orthogonal measurement), involvement and supply (from true or false lumen) of aortic branches, presence of thrombosis in the false lumen, signs of organ ischemia or vessel occlusion, aggressive blood pressure control with beta-blockers as they reduce both blood pressure and also heart rate hence reduce extra pressure on the aortic wall, immediate surgical repair (for type A dissection or complicated type B dissection), dissection and occlusion of branch vessels, abdominal organ ischemia eg kidneys (left kidney most common), bowel, spleen, aneurysmal dilatation: this is an indication for endovascular or surgical intervention. Visit ScienceDirect to see if you have access via your institution. 77 (6): 2012-20; discussion 2020. Chest radiography may be normal or demonstrate a number of suggestive findings, including: Depending on etiology, there may be signs of periaortic or mediastinal hematoma which include: CT, especially with arterial contrast enhancement (CTA) is the investigation of choice, able not only to diagnose and classify the dissection but also to evaluate for distal complications. 13. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. This discussion covers neck pain involving the posterior neck (not pain limited to the anterior neck) and low back pain, but it does not cover most major traumatic injuries (eg, fractures, dislocations, subluxations). In a very small minority, an underlying connective tissue disorder may be present. Although in general MRA has been reserved for follow-up examinations, rapid non-contrast imaging techniques (e.g. 137 (3): 250-258. Acute dissection of the descending aorta: noncommunicating versus communicating forms. AJR Am J Roentgenol. Causes include: The false lumen typically has higher and less pulsatile pressure, thought to be due to reduced distal outflow. In most cases the vessel wall is abnormal. Until the introduction of a sharp drop in 1783, this resulted in a long and painful death by strangulation (friends of the convicts often helped put them out of their misery by pulling on their legs). Neck pain and back pain are among the most common reasons for physician visits. (2018) BMJ (Clinical research ed.). 16. A new classification system was proposed which is referred with the acronym DISSECT (duration, intimal tear, size of the dissected aorta, the segmental extent of involvement, clinical complications, and thrombosis of the false lumen) 18. Multidetector CT of Aortic Dissection: A Pictorial Review. Ko JP, Goldstein JM, Latson LA, Azour L, Gozansky EK, Moore W, Patel S, Hutchinson B. Hurwitz LM, Goodman PC. (2010) Radiographics : a review publication of the Radiological Society of North America, Inc. 30 (2): 445-60. doi:10.1148/rg.302095104 - Pubmed. Other conditions or predisposing factors may also be encountered, in which case they will be reflected in the demographics. 2. 23. The aortic dissection detection risk score (ADD-RS) combined with a negative D-dimer test has been demonstrated to be effective in reducing unnecessary exams, however, it has not been widely accepted into clinical practice and requires further validation 13,14. The journal is the official publication for the Brazilian Society of Angiology and Vascular Surgery, the French Society for Vascular Surgery, the Vascular and Endovascular Surgery Society, the Southern California Vascular Surgical Society, Vascular Interventional Advances (VIVA), the Vascular Society of India, the Vascular Surgeons of Spanish Language, the Florida Vascular Society, and the Georgia Vascular Society. The duration of aortic dissection is arbitrarily categorized into three phases 18,19: Patients are often hypertensive (although they may be normotensive or hypotensive) and present with anterior or posterior chest pain and a tearing sensation in the chest. Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients. Two classification systems are in common usage, both of which divide dissections according to the involvement of the ascending aorta: In recent years, the Stanford classification has gained favor with cardiothoracic surgeons. There may be a difference in blood pressure between the two arms depending on where the dissection occurs. 9. de Lacey G, Morley S et-al. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. Over the 10 years following diagnosis another 15-30% of patients require surgery for life-threatening complications 5. In such instances, a number of features are helpful 3, 23: Chronic dissection flaps are often thicker and straighter than those seen in acute dissections 3. Lepage MA, Quint LE, Sonnad SS et-al. (2018). AJR Am J Roentgenol. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Emerg Med J. Conventional digital subtraction angiography has historically been the gold standard investigation. Effects of heart rate on motion artifacts of the aorta on non-ECG-assisted 0.5-sec thoracic MDCT. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Papers presented to the French Society for Vascular and Endovascular Surgery (SCVE), Guillaume Mahé, Gudrun Boge, Alessandra Bura-Rivière, Nabil Chakfé, Joël Constans, Yann Goueffic, Philippe Lacroix, Claire Le Hello, Gilles Pernod, Antonia Perez-Martin, Jean Picquet, Muriel Sprynger, the SFMV/SCVE group, the SFMV/SCVE group, Bahaa Nasr, Romain Didier, Mélanie Carret, Martine Gilard, Pierre Gouny, Yann Gouëffic, Freycon-Tardy Léonore, Faure Elsa, Peyre-Costa David, Canaud Ludovic, Branchereau Pascal, Marty-Ané Charles Henri, Alric Pierre, Picard Eric, Edoardo Pasqui, Gianmarco de Donato, Brenda Brancaccio, Giulia Casilli, Giulia Ferrante, Giancarlo Palasciano, Publication stage: In Press Journal Pre-Proof, M. Libby Weaver, Courtenay M. Holscher, Rebecca A. Sorber, Ying Wei Lum, Thomas Reifsnyder, Ahsan Zil-E-Ali, Victoria Kusztos, Tanya R. Flohr, Faisal Aziz, Sally Boyd, Wayne Tse, Kedar Lavingia, Michael Amendola, Jordan R Stern, Peter H. Connolly, Andrew J. Meltzer, Desarom Teso, Jill Sommerset, Matthew Dally, Beejay Feliciano, Yolanda Vea, Riyad Karmy Jones, Publication stage: In Press Corrected Proof, Juan Bautista Sánchez, Juan Diego Cuipal Alcalde, Rossi Ramos Isidro, Carlos Zúñiga Luna, W Samir Cubas, André Coaguila Charres, José Egoávil Gutiérrez, Juan David Ochoa, Patricia Fernández Arias, Orkun Doganer, Vincent Jongkind, Jan D. Blankensteijn, Kak Khee Yeung, Arno M. Wiersema, Maria Pia Borrelli, Adelaide Buora, Paola Scrivere, Massimo Sponza, Paolo Frigatti. 46 (2): 175-90. Signs of cardiac tamponade (Beck's triad) may also be encountered if rupture occurs into the pericardial space. (2021) Radiographics : a review publication of the Radiological Society of North America, Inc. 41 (2): 425-446. (2018) Circulation. McMahon MA, Squirrell CA. Aortic dissection is the prototype and most common form of the acute aortic syndromes and a type of arterial dissection. Mosby Inc. (2007) ISBN:0323040683. The American Journal of Surgery is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. On CT, a number of entities that can mimic a dissection should be considered 5: Clinically, a number of causes of acute chest pain are often considered: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 11. It has similar sensitivity and specificity to CTA and TOE 5 but suffers from limited availability and the difficulties inherent in performing MRI on acutely unwell patients. 79 (3): 567-73. Saunders Ltd. ISBN:0702030465. The omohyoid muscle consists of 2 fleshy bellies united by a central tendon. You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. 5. The majority of aortic dissections are seen in elderly hypertensive patients. We use cookies to help provide and enhance our service and tailor content. 2003;181 (2): 309-16. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 1949-1972. Aortic dissection is the prototype and most common form of the acute aortic syndromes and a type of arterial dissection.It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks longitudinally along with the media, forming a second blood-filled channel (false lumen) within the vessel wall. Most head and neck cancers are derived from the mucosal epithelium in the oral cavity, pharynx and larynx and are known collectively as head and neck … Emergency Medicine Journal 2001;18:183-185. Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer.
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