Thoracic Aortography and Bronchial Angiography

Detect acute and chronic aortic injury

Preoperative delineation of aortic aneurysm and dissections

PURPOSE

Biplane film changers

Lateral images require arms be moved posteriorly

Injection of CM from 25-35 ml/sec for a total volume of 50-70ml

Filming begin simultaneously

Exposure made in each plane

Exposure made at end of suspended inhalation

PROCEDURE

Aorta

Structures demonstrated for RAO/LAO 45 degrees

Thoracic aorta

Proximal brachiocephalic vessels

STRUCTURES DEMONSTRATED for CR to Center of Chest (Level of T6)

Brachiocephalic artery

Ascending aorta

Right and left coronary artery

Descending thoracic aorta

Left subclavian artery

Left carotid artery

STRUCTURES DEMONSTRATED for AP

Descending aorta

Ascending aorta

STRUCTURES DEMONSTRATED for lateral position

Aortic Trauma

Chronic Aortic Pseudo Aneurysm

Aortic Diverticula

Aortic Dissection

INDICATIONS OF THORACIC AND BRONCHIAL AORTOGRAPHY

AORTIC ANEURYSM

TRAUMATIC ANEURYSM

DISSECTING ANEURYSM

CLINICAL ASPECTS

Localized widening in the wall of BV

Some dilatation of aorta in arteriosclerosis

No sharply defined differentiation between simple dilatation and aneurysm

The define local area of cylindrical or saccular enlargement

AORTIC ANEURYSM

Raptured of the aorta caused by trauma can lead to exsanguination and death

Adventitia is spared and raptured is incomplete, patient may survive

Survival depends on mediastinal hematoma (prevents exsanguination)

Patients admitted with acute injury are 40-50% risk of exsanguination within the first 24 hours is high as 90% by 1 month after injury

TRAUMATIC ANEURYSM

Most common disease affecting the aorta, raptured abdominal aortic aneurysms, acute myocardial infarction, cocaine abuse, and involve pregnant women.

DISSECTING ANEURYSM

Severe Chest Pain

Back Pain

Abdominal Pain

Neck Pain

Dyspnea

Hoarseness

Nausea

Vomiting

Anuria

TYPICAL SYMPTOMS

Pericardial Tamponade

Secondary Myocardial or Cerebral Infarction

Rupture or Mesenteric or Renal Ischemia

DEATH RESULTS