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Surgeries of the Thoracic Aorta

Chapter by: Martinez-Jimenez, Santiago; Garrana, Sherief
in: CT and MR in Cardiology by Abbara, Suhny; Achenbach, Stephan
Elsevier
pp. -
ISBN: 9780323582124
CID: 5667412

Postcardiovascular Surgery Findings of the Thoracic Aorta

Garrana, Sherief; Martínez-Jiménez, Santiago
Various disease processes may affect the ascending thoracic aorta, aortic arch, and/or descending thoracic aorta, including aneurysms, dissections, intramural hematomas, penetrating atherosclerotic ulcers, and aortic transection/rupture. Many of those conditions require surgical intervention for repair. Multiple open and endovascular techniques are used for treatment of thoracic aortic pathology. It is imperative that the cardiothoracic radiologist have a thorough knowledge of the surgical techniques available, the expected postoperative imaging findings, and the complications that may occur to accurately diagnose life-threatening pathology when present, and avoid common pitfalls of misinterpreting normal postoperative findings as pathologic conditions.
PMID: 30454814
ISSN: 1557-8275
CID: 5646632

Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis

Garrana, Sherief H; Buckley, Jennifer R; Rosado-de-Christenson, Melissa L; Martínez-Jiménez, Santiago; Muñoz, Phillip; Borsa, John J
Fibrosing mediastinitis is a rare benign but potentially life-threatening process that occurs because of proliferation of fibrotic tissue in the mediastinum. The focal subtype is more common and typically is associated with an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young at presentation, but a wide age range has been reported, without a predilection for either sex. The diffuse form may be idiopathic or associated with autoimmunity, usually affects middle-aged and/or elderly patients, and is more common in men. For both subtypes, patients present with signs and symptoms related to obstruction or compression of vital mediastinal structures. The most common presenting signs and symptoms are cough, dyspnea, recurrent pneumonia, hemoptysis, and pleuritic chest pain. Patients with the diffuse subtype may have additional extrathoracic symptoms depending on the other organ systems involved. Because symptom severity is variable, treatment should be individualized with therapies tailored to alleviate compression of the affected mediastinal structures. Characteristic imaging features of fibrosing mediastinitis include infiltrative mediastinal soft tissue (with or without calcification) with compression or obstruction of mediastinal vascular structures and/or the aerodigestive tract. When identified in the appropriate clinical setting, these characteristic features allow the radiologist to suggest the diagnosis of fibrosing mediastinitis. Careful assessment is crucial at initial and follow-up imaging for exclusion of underlying malignancy, assessment of disease progression, identification of complications, and evaluation of treatment response. Online supplemental material is available for this article. ©RSNA, 2019.
PMID: 30951437
ISSN: 1527-1323
CID: 5646642