Pseudoaneurysms of the Ascending Aorta Demonstrated
With “Motion-Free” Multislice Computed Tomography
Filippo Cademartiri, MD; Koen Nieman, MD; Nico Mollet, MD;
Pim J. de Feyter, MD, PhD; Gabriel P. Krestin, MD, PhD
derived from respiration and heartbeat. Respiratory motion
can be suppressed performing the scan during breath hold.
Cardiac motion needs a very fast scan time in order to be
A 54-year-old man was referred to our hospital for acute
chest pain and suspected dissection of the thoracic aorta. A
contrast-enhanced 4-row multislice computed tomography
(MSCT) angiography (volume zoom, Siemens Medical So-
lutions, Forchheim, Germany) demonstrated a type A dissec-
tion (Figure 1). At surgery, a graft was positioned at the level
of aortic valve and another one at the level of the ascending
aorta. After 8 months, the patient underwent contrast-
he main challenge of noninvasive vascular imaging of
the heart and thorax is the reduction of motion artifacts
enhanced 16-row MSCT angiography (sensation 16, Siemens
Medical Solutions, Forchheim, Germany) with retrospective
ECG gating to reduce motion artifacts from heartbeat (Fig-
ures 2 and 3).
Three pseudoaneurysms are clearly demonstrated in both
the axial and the multiplanar reconstructions (Figure 2), as
well as with 3-dimensional volume rendering (Figure 3,
Movies I and II). Two small pseudoaneurysms are located
anteriorly at the root of the ascending aorta (Figures 2D and
2E), and a larger one is located anteriorly but at the level of
the junction of the ascending aorta and aortic arch before the
origin of the right brachiocephalic trunk (Movie III).
Motion artifacts are completely suppressed, and image
quality is high also in the visualization of coronary arteries.
From the Department of Radiology (F.C., K.N., N.M., P.J.d.F., G.P.K.) and the Department of Cardiology, Thoraxcentrum (K.N., N.M., P.J.d.F.),
Erasmus Medical Center, Rotterdam, The Netherlands.
Movies are available in the online-only Data Supplement at http://www.circulationaha.org.
Correspondence and reprint requests to Filippo Cademartiri, MD, Department of Radiology, Erasmus Medical Center, Dr Molenwaterplein, 40, 3015
GD, Rotterdam, The Netherlands. E-mail firstname.lastname@example.org
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and
Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute,
6720 Bertner Ave, MC1-267, Houston, TX 77030.
© 2004 American Heart Association, Inc.
Circulation is available at http://www.circulationaha.orgDOI: 10.1161/01.CIR.0000116602.10533.2E
Images in Cardiovascular Medicine
Figure 1. Contrast-enhanced 4-row MSCT at patient’s presenta- Download full-text
tion. In a scan performed during the very early arterial phase (Early
arterial panel), contrast material is only inside the true lumen of the
dissection (arrow), whereas the false lumen is still unenhanced (*).
In a later phase (Late arterial panel), the true lumen (arrow) and
false lumen (*) are both perfused by contrast material.
Figure 2. Follow-up contrast-enhanced 16-row MSCT. Axial slices
performed at the level of the caudal (A) and cranial (B) ends of the
graft in the ascending aorta (Ao) demonstrate 3 pseudoaneurysms. A
very small pseudoaneurysm (A and E, arrowheads) is located on the
left anterolateral wall of the ascending aorta, at the caudal end. A big-
ger one (A and D, thin arrow) is located on the anterior wall of the
ascending aorta, at the caudal end. A third, large one (B and C, thick
arrow) is located on the anterior wall of the ascending aorta, at the
Figure 3. Three-dimensional volume rendering of the follow-up
16-row MSCT scan. A panoramic view of the thorax is displayed
in panel A after segmentation of the anterior thoracic wall. Con-
figuration of the grafted ascending aorta (Ao) is nicely depicted
as well as the right coronary artery (RCA). After segmentation of
bones and pulmonary vessels, only the heart and the thoracic
aorta are left for visualization (B and C). Location and configura-
tion of the 3 pseudoaneurysms are displayed (arrowhead for the
small caudal one, thin arrow for the bigger caudal one, and
thick arrow for the large cranial one; panel C). RV indicates right
ventricle; LV, left ventricle.
February 17, 2004