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Aortic Stenosis: Spectrum of Diseases Depicted at Multisection CT¹

¹ From the Institut de Diagnòstic per la Imatge (C.S., M.P.L., E.C.) and the Department of Radiology (S.Q., R.B., A.A.C.), Vall d’Hebron Teaching Hospital, Passeig Vall d’Hebron 119–129, 08035 Barcelona, Spain. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received February 7, 2003; revision requested March 18; final revision received May 20; accepted May 22. Address correspondence to C.S. (e-mail: sebastia@hg.vhebron.es).

View larger version (104K): [in a new window]   Figure 1a.  Congenital aortic coarctation. (a, b) Left lateral (a) and frontal (b) volume-rendered images show aortic narrowing below the left subclavian artery (large arrow). Elongation of the supraaortic vessels also is visible (small arrow in a). (c) Contrast-enhanced axial CT scan shows enlarged internal mammary arteries (large arrows), intercostal arteries (small arrows), and descending scapular arteries (arrowheads). (d, e) Left lateral volume-rendered images show the internal mammary artery (arrowheads in d), the intercostal arteries (arrows in e), and the descending scapular arteries (arrowheads in e).

View larger version (157K): [in a new window]   Figure 1b.  Congenital aortic coarctation. (a, b) Left lateral (a) and frontal (b) volume-rendered images show aortic narrowing below the left subclavian artery (large arrow). Elongation of the supraaortic vessels also is visible (small arrow in a). (c) Contrast-enhanced axial CT scan shows enlarged internal mammary arteries (large arrows), intercostal arteries (small arrows), and descending scapular arteries (arrowheads). (d, e) Left lateral volume-rendered images show the internal mammary artery (arrowheads in d), the intercostal arteries (arrows in e), and the descending scapular arteries (arrowheads in e).

View larger version (78K): [in a new window]   Figure 1c.  Congenital aortic coarctation. (a, b) Left lateral (a) and frontal (b) volume-rendered images show aortic narrowing below the left subclavian artery (large arrow). Elongation of the supraaortic vessels also is visible (small arrow in a). (c) Contrast-enhanced axial CT scan shows enlarged internal mammary arteries (large arrows), intercostal arteries (small arrows), and descending scapular arteries (arrowheads). (d, e) Left lateral volume-rendered images show the internal mammary artery (arrowheads in d), the intercostal arteries (arrows in e), and the descending scapular arteries (arrowheads in e).

View larger version (102K): [in a new window]   Figure 1d.  Congenital aortic coarctation. (a, b) Left lateral (a) and frontal (b) volume-rendered images show aortic narrowing below the left subclavian artery (large arrow). Elongation of the supraaortic vessels also is visible (small arrow in a). (c) Contrast-enhanced axial CT scan shows enlarged internal mammary arteries (large arrows), intercostal arteries (small arrows), and descending scapular arteries (arrowheads). (d, e) Left lateral volume-rendered images show the internal mammary artery (arrowheads in d), the intercostal arteries (arrows in e), and the descending scapular arteries (arrowheads in e).

View larger version (107K): [in a new window]   Figure 1e.  Congenital aortic coarctation. (a, b) Left lateral (a) and frontal (b) volume-rendered images show aortic narrowing below the left subclavian artery (large arrow). Elongation of the supraaortic vessels also is visible (small arrow in a). (c) Contrast-enhanced axial CT scan shows enlarged internal mammary arteries (large arrows), intercostal arteries (small arrows), and descending scapular arteries (arrowheads). (d, e) Left lateral volume-rendered images show the internal mammary artery (arrowheads in d), the intercostal arteries (arrows in e), and the descending scapular arteries (arrowheads in e).

View larger version (84K): [in a new window]   Figure 2.  Diagram of systemic thoracic (A and B), thoracoabdominal (B), and abdominal (C and D) collateral pathways in cases of aortic stenosis. In A, the thoracoacromial and descending scapular arteries (arising from the subclavian arteries) supply the poststenotic descending thoracic aorta with retrograde flow via the intercostal arteries. In B, the internal mammary arteries (arising from the subclavian arteries) connect both with the descending thoracic aorta via the intercostal arteries and with the external iliac arteries via the superior and inferior abdominal epigastric arteries. In C, the inferior intercostal arteries supply the external iliac arteries through the superficial and deep iliac circumflex arteries. In D, the lumbar arteries supply the internal iliac arteries via the inferior gluteal arteries.

View larger version (105K): [in a new window]   Figure 3a.  Aortic pseudocoarctation. Contrast-enhanced axial CT scan (a) and curved reformatted image (b) of the aortic arch depict multiple calcified aneurysms (large arrows) and stenoses (small arrows).

View larger version (107K): [in a new window]   Figure 3b.  Aortic pseudocoarctation. Contrast-enhanced axial CT scan (a) and curved reformatted image (b) of the aortic arch depict multiple calcified aneurysms (large arrows) and stenoses (small arrows).

View larger version (94K): [in a new window]   Figure 4a.  Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).

View larger version (124K): [in a new window]   Figure 4b.  Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).

View larger version (103K): [in a new window]   Figure 4c.  Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).

View larger version (107K): [in a new window]   Figure 4d.  Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).

View larger version (93K): [in a new window]   Figure 4e.  Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).

View larger version (113K): [in a new window]   Figure 5a.  Coronal volume-rendered images obtained in a 25-year-old man at follow-up after surgery for midaortic dysplastic syndrome. Note the long, narrowed aorta in a (small arrows) and the left-sided aortic bypass with stenosis at the lower end (arrowhead). The superior mesenteric aorta was also stenotic (not shown). A meandering mesenteric artery (large arrow) connects the inferior and superior mesenteric arteries. The extraanatomic left-sided aortic bypass (arrows) and a surgically implanted endoprosthesis (arrowhead) are visible in b.

View larger version (107K): [in a new window]   Figure 5b.  Coronal volume-rendered images obtained in a 25-year-old man at follow-up after surgery for midaortic dysplastic syndrome. Note the long, narrowed aorta in a (small arrows) and the left-sided aortic bypass with stenosis at the lower end (arrowhead). The superior mesenteric aorta was also stenotic (not shown). A meandering mesenteric artery (large arrow) connects the inferior and superior mesenteric arteries. The extraanatomic left-sided aortic bypass (arrows) and a surgically implanted endoprosthesis (arrowhead) are visible in b.

View larger version (107K): [in a new window]   Figure 6.  Diagram of visceral (A and B) and visceral-systemic (C) abdominal collateral pathways. The celiac trunk and superior mesenteric artery can supply each other with bidirectional blood flow (A). The superior and inferior mesenteric arteries also can supply each other bidirectionally through the Riolano arcade (ie, the meandering mesenteric artery) (B). The inferior mesenteric artery can supply blood to the internal iliac artery via the hemorrhoidal plexus (C).

View larger version (137K): [in a new window]   Figure 7a.  Total occlusion of the infrarenal abdominal aorta. (a) Contrast-enhanced axial CT scan shows a totally occluded infrarenal abdominal aorta (large arrow). Note the enlarged pancreaticoduodenal arcades (small arrows) and epigastric arteries (arrowheads). (b) Lateral volume-rendered image shows complete thrombosis of the infrarenal abdominal aorta and occlusion of the celiac trunk and superior mesenteric artery (large arrows). Note the patency of the inferior mesenteric artery (arrowhead) and the enlarged epigastric arteries in the abdominal wall (small arrows).

View larger version (129K): [in a new window]   Figure 7b.  Total occlusion of the infrarenal abdominal aorta. (a) Contrast-enhanced axial CT scan shows a totally occluded infrarenal abdominal aorta (large arrow). Note the enlarged pancreaticoduodenal arcades (small arrows) and epigastric arteries (arrowheads). (b) Lateral volume-rendered image shows complete thrombosis of the infrarenal abdominal aorta and occlusion of the celiac trunk and superior mesenteric artery (large arrows). Note the patency of the inferior mesenteric artery (arrowhead) and the enlarged epigastric arteries in the abdominal wall (small arrows).

View larger version (152K): [in a new window]   Figure 8a.  Total occlusion of the infrarenal abdominal aorta. (a) Sagittal reformatted image of the abdominal aorta depicts calcification and mural thrombosis (arrows). (b) Contrast-enhanced axial CT scan shows collateral circulation, epigastric arteries (large white arrows), circumflex arteries (small white arrows), an enlarged inferior mesenteric artery (arrowhead), and enlarged lumbar arteries (black arrows). (c) Sagittal maximum-intensity projection image shows enlarged epigastric arteries in the abdominal wall (arrows) and retrograde flow in the inferior mesenteric artery (arrowhead). (d) Coronal volume-rendered image shows a collateral pathway proceeding from the subcostal arteries through the circumflex arteries to the external iliac artery (arrows). Note the enlarged inferior mesenteric artery (arrowhead).

View larger version (139K): [in a new window]   Figure 8b.  Total occlusion of the infrarenal abdominal aorta. (a) Sagittal reformatted image of the abdominal aorta depicts calcification and mural thrombosis (arrows). (b) Contrast-enhanced axial CT scan shows collateral circulation, epigastric arteries (large white arrows), circumflex arteries (small white arrows), an enlarged inferior mesenteric artery (arrowhead), and enlarged lumbar arteries (black arrows). (c) Sagittal maximum-intensity projection image shows enlarged epigastric arteries in the abdominal wall (arrows) and retrograde flow in the inferior mesenteric artery (arrowhead). (d) Coronal volume-rendered image shows a collateral pathway proceeding from the subcostal arteries through the circumflex arteries to the external iliac artery (arrows). Note the enlarged inferior mesenteric artery (arrowhead).

View larger version (135K): [in a new window]   Figure 8c.  Total occlusion of the infrarenal abdominal aorta. (a) Sagittal reformatted image of the abdominal aorta depicts calcification and mural thrombosis (arrows). (b) Contrast-enhanced axial CT scan shows collateral circulation, epigastric arteries (large white arrows), circumflex arteries (small white arrows), an enlarged inferior mesenteric artery (arrowhead), and enlarged lumbar arteries (black arrows). (c) Sagittal maximum-intensity projection image shows enlarged epigastric arteries in the abdominal wall (arrows) and retrograde flow in the inferior mesenteric artery (arrowhead). (d) Coronal volume-rendered image shows a collateral pathway proceeding from the subcostal arteries through the circumflex arteries to the external iliac artery (arrows). Note the enlarged inferior mesenteric artery (arrowhead).

View larger version (172K): [in a new window]   Figure 8d.  Total occlusion of the infrarenal abdominal aorta. (a) Sagittal reformatted image of the abdominal aorta depicts calcification and mural thrombosis (arrows). (b) Contrast-enhanced axial CT scan shows collateral circulation, epigastric arteries (large white arrows), circumflex arteries (small white arrows), an enlarged inferior mesenteric artery (arrowhead), and enlarged lumbar arteries (black arrows). (c) Sagittal maximum-intensity projection image shows enlarged epigastric arteries in the abdominal wall (arrows) and retrograde flow in the inferior mesenteric artery (arrowhead). (d) Coronal volume-rendered image shows a collateral pathway proceeding from the subcostal arteries through the circumflex arteries to the external iliac artery (arrows). Note the enlarged inferior mesenteric artery (arrowhead).

View larger version (91K): [in a new window]   Figure 9a.  Takayasu arteritis. (a, b) Contrast-enhanced axial CT images of the lower thoracic aorta and upper abdominal aorta depict stenosis with mural calcification (arrows in a) and small aneurysms (arrow in b). (c) Sagittal volume-rendered image shows the stenotic segment in the lower thoracic aorta (arrows).

View larger version (99K): [in a new window]   Figure 9b.  Takayasu arteritis. (a, b) Contrast-enhanced axial CT images of the lower thoracic aorta and upper abdominal aorta depict stenosis with mural calcification (arrows in a) and small aneurysms (arrow in b). (c) Sagittal volume-rendered image shows the stenotic segment in the lower thoracic aorta (arrows).

View larger version (109K): [in a new window]   Figure 9c.  Takayasu arteritis. (a, b) Contrast-enhanced axial CT images of the lower thoracic aorta and upper abdominal aorta depict stenosis with mural calcification (arrows in a) and small aneurysms (arrow in b). (c) Sagittal volume-rendered image shows the stenotic segment in the lower thoracic aorta (arrows).

View larger version (152K): [in a new window]   Figure 10a.  Aortic dissection. (a) Contrast-enhanced axial CT image depicts a dissected aorta with a thrombosed false lumen (large arrow) and a small, enhanced true lumen (small arrow). The thrombosed false lumen compresses the celiac trunk ostium. Note the right kidney infarction due to a thrombosed renal artery (not shown). (b) Curved coronal reformatted image of the descending thoracic aorta depicts the thrombosed false lumen (large arrow) and stenotic true lumen (small arrow).

View larger version (141K): [in a new window]   Figure 10b.  Aortic dissection. (a) Contrast-enhanced axial CT image depicts a dissected aorta with a thrombosed false lumen (large arrow) and a small, enhanced true lumen (small arrow). The thrombosed false lumen compresses the celiac trunk ostium. Note the right kidney infarction due to a thrombosed renal artery (not shown). (b) Curved coronal reformatted image of the descending thoracic aorta depicts the thrombosed false lumen (large arrow) and stenotic true lumen (small arrow).

View larger version (101K): [in a new window]   Figure 11a.  Aortic stenosis in a 42-year-old man who had undergone surgical repair of aortic coarctation in childhood and whose symptoms at the time of scanning included hypertension and weak femoral pulses. (a, b) Contrast-enhanced axial CT images of the thoracic aorta show a calcified prosthesis (large arrow) in the proximal descending thoracic aorta. The prosthesis has become detached from the left wall, producing partial aortic thrombosis and stenosis (small arrow in b). Note the enlarged internal mammary arteries (arrowheads in a). (c) Sagittal oblique reformatted image of the thoracic aorta shows movement of the aortic stent-graft (large arrow) and secondary aortic stenosis (small arrow).

View larger version (105K): [in a new window]   Figure 11b.  Aortic stenosis in a 42-year-old man who had undergone surgical repair of aortic coarctation in childhood and whose symptoms at the time of scanning included hypertension and weak femoral pulses. (a, b) Contrast-enhanced axial CT images of the thoracic aorta show a calcified prosthesis (large arrow) in the proximal descending thoracic aorta. The prosthesis has become detached from the left wall, producing partial aortic thrombosis and stenosis (small arrow in b). Note the enlarged internal mammary arteries (arrowheads in a). (c) Sagittal oblique reformatted image of the thoracic aorta shows movement of the aortic stent-graft (large arrow) and secondary aortic stenosis (small arrow).

View larger version (165K): [in a new window]   Figure 11c.  Aortic stenosis in a 42-year-old man who had undergone surgical repair of aortic coarctation in childhood and whose symptoms at the time of scanning included hypertension and weak femoral pulses. (a, b) Contrast-enhanced axial CT images of the thoracic aorta show a calcified prosthesis (large arrow) in the proximal descending thoracic aorta. The prosthesis has become detached from the left wall, producing partial aortic thrombosis and stenosis (small arrow in b). Note the enlarged internal mammary arteries (arrowheads in a). (c) Sagittal oblique reformatted image of the thoracic aorta shows movement of the aortic stent-graft (large arrow) and secondary aortic stenosis (small arrow).

View larger version (88K): [in a new window]   Figure 12a.  Axillobifemoral bypass stenosis. (a, b) Axial CT images depict a subcutaneous axillobifemoral bypass (arrow in a) and a fluid collection from infection (arrow in b) surrounding and compressing the extraanatomic graft. (c, d) Lateral volume-rendered images of the axillobifemoral bypass show several mild stenoses and one severe stenosis (arrow) due to the periprosthetic fluid collection. Note the absence of enhancement in the infrarenal aorta in d, a result of thrombosis.

View larger version (148K): [in a new window]   Figure 12b.  Axillobifemoral bypass stenosis. (a, b) Axial CT images depict a subcutaneous axillobifemoral bypass (arrow in a) and a fluid collection from infection (arrow in b) surrounding and compressing the extraanatomic graft. (c, d) Lateral volume-rendered images of the axillobifemoral bypass show several mild stenoses and one severe stenosis (arrow) due to the periprosthetic fluid collection. Note the absence of enhancement in the infrarenal aorta in d, a result of thrombosis.

View larger version (114K): [in a new window]   Figure 12c.  Axillobifemoral bypass stenosis. (a, b) Axial CT images depict a subcutaneous axillobifemoral bypass (arrow in a) and a fluid collection from infection (arrow in b) surrounding and compressing the extraanatomic graft. (c, d) Lateral volume-rendered images of the axillobifemoral bypass show several mild stenoses and one severe stenosis (arrow) due to the periprosthetic fluid collection. Note the absence of enhancement in the infrarenal aorta in d, a result of thrombosis.

View larger version (111K): [in a new window]   Figure 12d.  Axillobifemoral bypass stenosis. (a, b) Axial CT images depict a subcutaneous axillobifemoral bypass (arrow in a) and a fluid collection from infection (arrow in b) surrounding and compressing the extraanatomic graft. (c, d) Lateral volume-rendered images of the axillobifemoral bypass show several mild stenoses and one severe stenosis (arrow) due to the periprosthetic fluid collection. Note the absence of enhancement in the infrarenal aorta in d, a result of thrombosis.

View larger version (142K): [in a new window]   Figure 13a.  Abdominal aortic stenosis due to retroperitoneal fibrosis. (a) Contrast-enhanced axial CT image shows an irregular mass (white arrows) around the abdominal aorta, producing severe aortic narrowing (black arrow). (b, c) Coronal (b) and sagittal (c) reformatted images of the abdominal aorta demonstrate severe aortic stenosis (black arrow) secondary to retroperitoneal fibrosis (white arrows).

View larger version (119K): [in a new window]   Figure 13b.  Abdominal aortic stenosis due to retroperitoneal fibrosis. (a) Contrast-enhanced axial CT image shows an irregular mass (white arrows) around the abdominal aorta, producing severe aortic narrowing (black arrow). (b, c) Coronal (b) and sagittal (c) reformatted images of the abdominal aorta demonstrate severe aortic stenosis (black arrow) secondary to retroperitoneal fibrosis (white arrows).

View larger version (132K): [in a new window]   Figure 13c.  Abdominal aortic stenosis due to retroperitoneal fibrosis. (a) Contrast-enhanced axial CT image shows an irregular mass (white arrows) around the abdominal aorta, producing severe aortic narrowing (black arrow). (b, c) Coronal (b) and sagittal (c) reformatted images of the abdominal aorta demonstrate severe aortic stenosis (black arrow) secondary to retroperitoneal fibrosis (white arrows).