J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 3 0 e3 3 2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Aortic dissection: The flood tide sign Umberto G. Rossi MDa,*, Sara Seitun MDb, Maurizio Cariati MDa a
Department of Radiology and Interventional Radiology, San Carlo Borromeo Hospital, Via Pio II, 3, 20153 Milano, Italy Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Genova, Italy b
article info
abstract
Article history:
Aortic dissection is a challenging medical and surgical problem. Its evolution depends on
Received 2 April 2013
size and location of its intimal tears. We describe a case of contrast enhanced MD-CT with
Received in revised form
low out flow of the false lumen for an unbalanced between the entry and the reentry tears.
18 August 2013
This determined a delayed filling up of the false lumen on the arterial phase that was
Accepted 3 September 2013
complete on the venous one. ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved.
Keywords: Aortic dissection False lumen CT Sign
A 66-year-old male underwent urgent replacement of the ascending aorta for an acute Stanford type-A (DeBakey type-I) aortic dissection. One month after repair, contrastenhanced multidetector CT (LightSpeed 16; GE Healthcare, Milwaukee, WI) was performed. Scan parameters were detector width, 1.25 mm; gantry rotation time, 500 milliseconds; effective temporal resolution, 250 milliseconds; feed, 27.5 mm/rotation; tube voltage, 120 kVp; tube current, 80e400 mAs. Contrast enhancement was achieved by injecting 100 mL of iodated contrast (Iomeron 400; Bracco, Milan, Italy) at a flow rate of 4.5 mL, followed by a 50-mL bolus of saline solution via an antecubital vein. The scan showed patency of the ascending aorta prosthesis, partial thrombosis of the false lumen of the aortic arch, and a persistent dissection of the descending aorta (Stanford
type-B, DeBakey type-III) with presence of an entry tear distal to the left subclavian artery and suspected lack of exit tears (Fig. 1). On the arterial phase (bolus-tracking synchronization) the false lumen showed delayed filling (Fig. 1AeD), compared with complete filling with a welldelineated blood/contrast level on the venous phase (immediately after the first pass) (Fig. 2AeD): the flood tide sign. The flood tide sign is a result of a low outflow of the false lumen with unbalanced flow between the entry and the reentry tears.1 The patient underwent therapeutic fenestration of the abdominal aorta.2 Multidetector CT at 3-month follow-up showed patency of the fenestration, reduction of the flood tide sign, and initial thrombosis of the false lumen (Fig. 3).
Conflict of interest: The authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (U.G. Rossi). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.09.001
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 3 0 e3 3 2
331
Fig. 1 e Contrast-enhanced multidetector CT artery phase axial images (AeC) show the dissected descending aorta with the true lumen on the right and delayed enhancement (from distal to proximal) of the false lumen. Sagittal maximum intensity projection display (D).
Fig. 2 e Contrast-enhanced multidetector CT venous phase axial images (AeC) show complete enhancement false lumen with a well-delineated level of contrast media. Sagittal maximum intensity projection display (D).
Fig. 3 e Contrast-enhanced multidetector CT venous phase axial image (A) at 3-month follow-up shows reduction of the level of enhancement, partial mural thrombosis within the false lumen, and stable luminal dimensions. Coronal maximum intensity display (B) confirmed the patency of the abdominal aorta fenestration (arrow).
332
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 3 0 e3 3 2
references
1. Tsai TT, Schlicht MS, Khanafer K, et al. Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection. J Vasc Surg. 2008;47:844e851.
2. Williams DM, Andrews JC, Marx MV, Abrams GD. Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations. J Vasc Interv Radiol. 1993;4:75e83.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Aortic dissection: The flood tide sign Umberto G. Rossi MDa,*, Sara Seitun MDb, Maurizio Cariati MDa a
Department of Radiology and Interventional Radiology, San Carlo Borromeo Hospital, Via Pio II, 3, 20153 Milano, Italy Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Genova, Italy b
article info
abstract
Article history:
Aortic dissection is a challenging medical and surgical problem. Its evolution depends on
Received 2 April 2013
size and location of its intimal tears. We describe a case of contrast enhanced MD-CT with
Received in revised form
low out flow of the false lumen for an unbalanced between the entry and the reentry tears.
18 August 2013
This determined a delayed filling up of the false lumen on the arterial phase that was
Accepted 3 September 2013
complete on the venous one. ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved.
Keywords: Aortic dissection False lumen CT Sign
A 66-year-old male underwent urgent replacement of the ascending aorta for an acute Stanford type-A (DeBakey type-I) aortic dissection. One month after repair, contrastenhanced multidetector CT (LightSpeed 16; GE Healthcare, Milwaukee, WI) was performed. Scan parameters were detector width, 1.25 mm; gantry rotation time, 500 milliseconds; effective temporal resolution, 250 milliseconds; feed, 27.5 mm/rotation; tube voltage, 120 kVp; tube current, 80e400 mAs. Contrast enhancement was achieved by injecting 100 mL of iodated contrast (Iomeron 400; Bracco, Milan, Italy) at a flow rate of 4.5 mL, followed by a 50-mL bolus of saline solution via an antecubital vein. The scan showed patency of the ascending aorta prosthesis, partial thrombosis of the false lumen of the aortic arch, and a persistent dissection of the descending aorta (Stanford
type-B, DeBakey type-III) with presence of an entry tear distal to the left subclavian artery and suspected lack of exit tears (Fig. 1). On the arterial phase (bolus-tracking synchronization) the false lumen showed delayed filling (Fig. 1AeD), compared with complete filling with a welldelineated blood/contrast level on the venous phase (immediately after the first pass) (Fig. 2AeD): the flood tide sign. The flood tide sign is a result of a low outflow of the false lumen with unbalanced flow between the entry and the reentry tears.1 The patient underwent therapeutic fenestration of the abdominal aorta.2 Multidetector CT at 3-month follow-up showed patency of the fenestration, reduction of the flood tide sign, and initial thrombosis of the false lumen (Fig. 3).
Conflict of interest: The authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (U.G. Rossi). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.09.001
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 3 0 e3 3 2
331
Fig. 1 e Contrast-enhanced multidetector CT artery phase axial images (AeC) show the dissected descending aorta with the true lumen on the right and delayed enhancement (from distal to proximal) of the false lumen. Sagittal maximum intensity projection display (D).
Fig. 2 e Contrast-enhanced multidetector CT venous phase axial images (AeC) show complete enhancement false lumen with a well-delineated level of contrast media. Sagittal maximum intensity projection display (D).
Fig. 3 e Contrast-enhanced multidetector CT venous phase axial image (A) at 3-month follow-up shows reduction of the level of enhancement, partial mural thrombosis within the false lumen, and stable luminal dimensions. Coronal maximum intensity display (B) confirmed the patency of the abdominal aorta fenestration (arrow).
332
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 3 0 e3 3 2
references
1. Tsai TT, Schlicht MS, Khanafer K, et al. Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection. J Vasc Surg. 2008;47:844e851.
2. Williams DM, Andrews JC, Marx MV, Abrams GD. Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations. J Vasc Interv Radiol. 1993;4:75e83.
