What is thoracic aorta tortuosity
Abdominal aorta in the norm and in pathology
Normal abdominal aorta
The normal adult aorta in a transverse section is measured by the maximum internal diameter, which ranges from 3 cm at the level of the xiphoid process to 1 cm at the level of the bifurcation. The cross and vertical section diameters must be the same.
Measurements should be taken at different levels along the entire length of the aorta. Any significant increase in the diameter below the localized department is a pathology.
The aorta can be displaced in scoliosis, retroperitoneal tumors or a lesion of para-aortic lymph nodes; In some cases, it can simulate an aneurysm. A thorough transverse examination is required to identify the pulsating aorta: lymph nodes or other extrasortic lesions are visualized behind or around the aorta.
If the aorta is more than 5 cm in diameter in cross-section, urgent attention should be paid to the clinician. There is a high risk of an aortic rupture this diameter.
A significant increase in the diameter of the aorta in the deeper areas (towards the pelvis) is pathological; evidence of an increase in the diameter of the aorta above normal is also very suspicious of aneurysmal enlargement. However, it is necessary to distinguish the aneurysm from an aortic dissection, and in the elderly, significant tortuosity of the aorta can obscure the aneurysm. The aneurysm can be diffuse or local, symmetrical and asymmetrical. Internal reflection echoes occur in the presence of a clot (thrombus), which can narrow the lumen. If a thrombus is detected in the lumen, the measurement of the vessel must include both a thrombus and a zonegativnytic lumen of the vessel. It is also important to measure the length of the pathologically altered site.
For a pulsating aneurysm it is clinically possible to take a "horseshoe-shaped kidney", a tumor of the retroperitoneal space, and altered lymph nodes. The horseshoe kidney can appear anechogenic and pulsating because the isthmus is on top of the aorta. Cross-sections and, if necessary, slices at an angle help differentiate the aorta and kidney structure.
The aortic cross-section should not exceed 3 cm in any area, if the diameter is more than 5 cm, or if the aneurysm increases sharply (an increase of more than 1 cm per year is considered rapid), there is a significant likelihood of stratification.
When detecting fluid swelling in the area of the aortic aneurysm and when the patient is in pain, the situation is considered very serious. This can mean stratification with blood loss.
Stratification can be done at any level of the aorta over a short or long stretch. More often, the bundle may be in the thoracic aorta, which is difficult to see with ultrasound. An aortic dissection can create the illusion of doubling the aorta or doubling the lumen. The presence of a thrombus in the lumen can largely mask the bundle as the aortic lumen becomes narrowed.
In either case, if the aortic diameter changes, both a reduction and an increase, stratification can be suspected. Longitudinal and cross sections are very important in determining the overall length of the patch; It is also necessary to make oblique cuts to clarify the prevalence of the process.
When an aortic aneurysm or dissection is detected, the first step is to visualize the renal arteries and determine whether or not they are affected by the process prior to surgery. If possible, it is also necessary to determine the condition of the pelvic arteries.
Constriction of the aorta
Any local aortic narrowing is significant and should be visualized and measured in two planes, using longitudinal and transverse sections to determine the prevalence of the process.
Atheromatous calcification can be detected throughout the aorta. If possible, it is necessary to trace the aorta after bifurcation along the right and left pelvic arteries, which should also be examined for stenosis or enlargement.
In the elderly, the aorta can become folded and narrowed as a result of atherosclerosis, which can be focal or diffuse. Calcification of the aortic wall creates hyperechoic areas with acoustic shadows. Thrombosis can develop, especially at the level of the aortic bifurcation, followed by occlusion of the vessel. In some cases, a Doppler exam or aortography (contrast radiography) is required. Before diagnosing stenosis or enlargement, it is necessary to examine all departments of the aorta.
If the patient has undergone an aortic prosthesis, it is important to echograph the location and size of the prosthesis using cross-sections to avoid delamination or blood loss. The fluid near the graft can be a result of bleeding, but it can also be the result of limited edema or inflammation after surgery. It is necessary to establish a correlation between the clinical data and the results of the ultrasound. In all cases, it is necessary to determine the total length of the prosthesis, as well as the condition of the aorta above and below it.
Aneurysms with unspecific aortitis are more common in women under the age of 35, but they are sometimes detected in children. The aorta can affect any part of the descending aorta and can cause tubular expansion, asymmetrical enlargement, or stenosis. For the detection of lesions, a thorough examination in the projection of the renal arteries is necessary. Patients with aortitis need to have an ultrasound every 6 months as the stenosis can then widen and become an aneurysm. Since echography does not provide visualization of the thoracic aorta, it is necessary to perform aortography to determine the condition of the aorta from the aortic valve to the aortic bifurcation and to determine the condition of the main branches.
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