Aneurysm of the Abdominal Aorta
A 76-year-old man was admitted to the intensive care unit with unstable angina pectoris of Braunwald class IIIB. He was known to have hypertension, which was poorly controlled with medication. Physical examination revealed a pulsating mass in the lower abdomen that was suggestive of an aortic aneurysm. An echocardiographic study with a small, hand-held ultrasound device (SonoHeart, SonoSite Inc) showed an abdominal aortic aneurysm containing thrombotic material (Figure 1). His troponin T level was elevated, and he underwent coronary arteriography, which showed a high-grade stenosis at the bifurcation of left anterior descending artery and the first diagonal branch. The lesion was dilated during the same session, with direct stenting of both branches.
After the intracoronary intervention, intravascular ultrasound imaging of the abdominal aneurysm was performed (motorized pullback with speed of 0.5 mm/s) with a 9 MHz, mechanically rotated imaging transducer (Figure 2). The transducer was rotating in a 9 French, close-end, rounded-tip catheter that was 110 cm in length (Ultra ICE, Boston Scientific).
A multislice spiral computed tomography scan (Somatom plus 4 VolumeZoom, Siemens AG) was also performed (Figure 3). By simultaneous acquisition of four 1-mm slices at a pitch of 5 (5 mm Z-translation per 0.5-s gantry rotation), images of the entire area of the abdominal aorta were acquired within 32 seconds. Contrast between the vessel lumen and surrounding tissues was realized by an intravenous injection of 100 mL of Iomeprol (Bracco-Byk Gulden) at an injection rate of 2.5 mL/s. From the data set, a large stack of axial slices was reconstructed and processed with dedicated volume-rendering software (VoxelView, Vital Images) on a separate graphic workstation.
One month later, the patient underwent surgical resection of the aneurysm. He was asymptomatic at the 6-month follow-up.
An animated version of this figure can be found at http://www.circulationaha.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.
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