9 Prominent Ascending Aorta or Aortic Arch

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig CA 9-1 Hypertensive heart disease. Marked dilatation (arrows) of the ascending aorta caused by increased aortic pressure.

• Fig CA 9-2 Atherosclerosis. Generalized tortuosity and elongation of the ascending aorta (open arrows) and descending aorta (closed arrows).

• Fig CA 9-3 Aortic valvular stenosis. There is prominence of the left ventricle with poststenotic dilatation of the ascending aorta (arrowheads). The aortic knob and descending aorta (arrows) are normal.10

• Fig CA 9-4 Aortic insufficiency. Marked dilatation of the ascending aorta (arrows), suggesting some underlying aortic stenosis. The left ventricle is enlarged with downward and lateral displacement of the cardiac apex. Note that the cardiac shadow extends below the dome of the left hemidiaphragm (small arrow).

• Fig CA 9-5 Syphilitic aortitis. Aneurysmal dilatation of the ascending aorta with extensive linear calcification of the wall (arrows). Some calcification is also seen in the distal aortic arch.

• Fig CA 9-6 Pseudocoarctation of the aorta. (A) Frontal view of the chest demonstrates two bulges (arrows) producing a well-demarcated figure-3 sign in the region of the aortic knob. The upper bulge (black arrow) is higher than the normal aortic knob and simulates a mediastinal mass. Because there is no hemodynamic abnormality, the heart is normal in size, and there is no rib notching. (B) In another patient, an aortogram demonstrates extreme kinking of the descending aorta (arrow) without an area of true coarctation.

• Fig CA 9-7 Patent ductus arteriosus. A convex bulge (arrows) on the left side of the superior mediastinum represents dilatation of the aortic end of the ductus (“ductus bump”).

• Fig CA 9-8 Corrected transposition with ventricular septal defect. (A) There is fullness of the upper left border of the heart (arrows). Because of the left-to-right ventricular shunt, the pulmonary vasculature is engorged. (B) A film from an angiocardiogram demonstrates the inverted aorta and right ventricular outflow tract (arrows).6

• Fig CA 9-9 Marfan's syndrome. Arteriogram shows enormous dilatation of the aneurysmal ascending aorta.