Acute Aortic Syndrome

OVERVIEW

• Chest pain with ischemic symptoms and haemodynamic compromise can occur acutely due to a spectrum of aortic pathologies known as the acute aortic syndrome
• the rate of aortic rupture is higher in penetrating atheromatous ulcer (42%) and intramural hematoma (35%) than in aortic dissection (types A 7.5% and type B 4.1%)

TYPES

• Penetrating atheromatous ulcer – rupture of an atheromatous plaque through the internal elastic lamina, with subsequent localized medial disruption and potential dissection, pseudoaneurysm formation, or free rupture
• Intramural hematoma – rupture of the vasa vasorum or hemorrhage within an atherosclerotic plaque followed by aortic wall infarct
• Aortic dissection- an intimal tear with resultant propagation within the middle third of the medial layer of the aorta
• Aneurysm leak or rupture – progressive vessel dilation and increased wall tension
• Traumatic transection – rapid deceleration forces or direct trauma, commonly shearing distal to left subclavian artery at aortic isthmus where the aorta is fixed by ligamentum arteriosum

 References and Links

LITFL

• CCC — Acute Aortic Dissection

Journal articles

• Sheikh A, Ali K, Mazhar S. Acute Aortic Syndrome. Circulation 2013;128:1122-1127
• Ueda T, Chin A, Petrovitch I, Fleischmann D. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights Imaging. 2012 Dec;3(6):561-71. doi: 10.1007/s13244-012-0195-7. Epub 2012 Nov 6. PubMed PMID: 23129238; PubMed Central PMCID: PMC3505562.