SEMIOLOGY OF VESSELS

IMAGING
 SEMIOLOGY OF VASCULAR SYSTEM
• DILATATION
- Aneurysm
- Dissection
• NARROWING
- Stenosis
- Occlusion
- External compression
• CONGENITAL MALFORMATION
- Left arch/ aberrant right subclavian
- Right arch / aberrant left subclavian artery
- Right arch with mirror image branching
- Coartation / pseudocoartation (aortic kink)
 Dilatation of artery
• Dilatation of artery wall.

• Divided into 3 types:

- True aneurysm (three layers intact)
- False /pseudo- aneurysms
(disruption of all 3 layers )
- Inflammation
Dilatation of artery
 Dilatation of artery

TYPE OF ANEURYSM / SHAPE

THERE IS TWO TYPE OF

ANEURYSM SHAPE :

1- Fusiform

2- Saccular
Dilatation of artery
 Dilatation of artery
RUPTURE RISK OF ANEURYSM

• Diameter (> 6cm)

• Expansion (> 0.6 cm / year)
• Smoking / COPD
• Family history
• Hypertension
• Gender (Female )
• Shape (Fusiform < saccular)
 Dilatation of artery
DIAGNOSIS OF ANEURYSM
• Physical examination (mass / pulse…)
• X-Ray (calcification wall / enlargement..)
• Ultrasound / Doppler US
• ACT (Angiogram Computed Tomography)
• MRA (Magnetic Resonance Angiogram)
• Angiography (Therapeutic/ evaluate)
 Dilatation of artery

DIAGNOSIS OF ANEURYSM
• Physical examination:
- Mass palpable with pulsatility
- Auscultation
• Plain Radiograph
Calcification of the wall of aneurysm

• Ultrasound / Doppler ultrasound

 Dilatation of artery
DIAGNOSIS OF ANEURYSM

• Conventional X-Ray
Chest X-ray (PA view)
Abnormality of contour
and tortuosity of the
aorta with calcifications
within vessels wall.
 Dilatation of aneurysm
DIAGNOSIS OF ANEUVRYSM
Computed tomography angiogram
Without IVC : Calcification & dilatation
With IVC : Enhanced vessels to different from other structure neighbor.

Axial
3 D rec.
plan IVC Axial IVC bony window
 Dilatation of artery
Diagnosis of aneurysm

• Angiography:
Performs with
contrast media
under special type
of fluoroscopy (C –
arm type)
 Dilatation of artery
Diagnosis of aneurysm

• CTA and AMRI

- Increased diameter of
artery size.
- Mural thrombus
- Calcifications
- Luminal patency
- Mass effect

CTA : Aneurysm of ascending

aorta

MRA : Aneurysm of ascending aorta

 Dilatation of artery
Diagnosis of aneurysm
Inflammatory aneurysm

- due to fibrosis occurs in

the wall of artery.
- MRA and FDG-PET are
unreliable (new research
in 2008)

Inflammatory aneurysm of
abdominal aorta (CTA
reconstruction 3D)
Dissection arteries
 CAROTID ARTERY ANEURYSM

Extra cranial
aneurysm:
Cause:

- Trauma
- Infection
- Congenital (rare)

Angiography

Duplex ultrasound of
Common Carotid Artery
 ICA ANEURYSM / PARIETAL
THROMBOSIS

DUPLEX ULTRASOUND

ICA ANEURYSM / PARIETAL

VESSELS THICKENING AND
THROMBOSIS
ICA ANEURYSM / PARIETAL
THROMBOSIS

Giant aneurysm in left ICA

on nonenhanced CT scans

MRI : T1 Weighted
Giant mass surrounded by
edema tissue
ARTERIO-VENOUS FISTULA
 STENOSIS OF CAROTID ARTERY

External carotid artery

stenosis:
PS increased 426 .7 cm /s
ED 25 cm/s

Internal carotid artery with

high resistant (blood supply
decreased).,
Elderly patient : vertigo
INTERNAL CAROTID ARTERY STENOSIS

STRING SIGN

ANGIO-CT INTERNAL
CAROTID ARTERY
STENOSIS.

STENOSIS INTERNAL
CAROTID ARTERY
(on CE-MRA)
Cause of stenosis carotid artery
ULCERATED PLAQUE OR TWINKLE
ARTIFACT (ICA)

Tahmasebpour HR et al. Radiographics 2005; 25 : 1561-1575

VERTEBRAL ARTERY STENOSIS
Symptom sign of VS :

- Vertigo
- Ataxia
- Loss of balance

Diagnostic based to
- Duplex
- ACT
- MRA
VERTEBRAL ARTERY STENOSIS
THORAX & ABDOMEN
VESSELS
BRIEF ANATOMY OF VASCULAR
(THORAX & ABDOMEN)
BRIEF ANATOMY OF VASCULAR
(THORAX & ABDOMEN)
 Congenital anomalies
Left arc / aberrant right subclavian artery
Most common arc
anomaly.
1% found individual
Arise from 4th branch of
the arc and cross
mediastinum to reach
right arm.

AMRI and CTA

- Dilatation (higher than
normal aorta arc).
- Can associated with
congenital heart
disease about 10 % of
these cases
 ANGIO-MRI

AORTIC ARC :

- RCCA : right common carotid a.

- RSCA : right subclavian a.
- RVA : right vertebral artery
- LVA : left vertebral a.
- LSCA : left subclavian a.
GREAT VESSELS
 GREAT VESSELS : AORTA
Aorta aneurysm
• USG
. Most secondary to
degenerative & arterosclerosis
disease of the tunica media
. True aneurysm :all layers are
False aneuvrysm
included
. False aneurysm : not all layers
are include usually just adventitia

True aneurysm
 GREAT VESSELS : AORTA
Thoracic aortic aneurysm
• Aortography
Actual: not diagnostic, replaced
by ACT but treatment (stent)
• CHEST X-Ray:
Dilated & tortuous aorta with
calcification.
• Angio- Computed Tomography
 AORTIC DISSECTION
Spontaneous longitudinal separation of
aortic intima and adventitia by circulating
blood having gained access to media of the
aortic wall splitting it in two.
(Intima tear).
CXR :
Calcification (compare with previous
X- Ray)
USG :
- Intima Flap Real time
- Double barrel
 AORTIC DISSECTION

MRI :
- Intimal flip (SE image)

AMRI : SE : The entry sites is visualized as focal

interruption of the linear image of the intima flap
 STENOSIS OF ARTERY

Angiography of left subclavian

artery:

Stenosis
ABDOMINAL VESSELS
BRIEF ANATOMY OF ABDOMEN
 PORTAL VEIN PATHOLOGY
• Thrombosis portal vein

• Artero-portal fistula

• Portal vein aneurysm

 ABDOMINAL AORTA ANEURYSM
Angiography of abdominal aorta & USG

Focal dilatation of just above

0.5 cm at level bifurcation CIA.
Focal widening > 3 cm
Frequent man > woman
60 %
Cause:
. Aorta dissection
. Arteerosclerosis
. Traumatic
. Congenital
. Syphilis
. Mycotic (infection)
. Aortitis
. Increased pressure (HBP, stenosis valve)
 AORTIC DISSECTION
CECT :
- Crescentic high –attenuation clot
within false lumen.
- displaced intima calcification
- Intima flap separating two aortic
channels.
RENAL ARTERY
 Renal artery normal
INVESTIGATION RENAL ARTERY THROUGH
ECHO-DOPPLER

INVESTIGATION SEGMENTAL ARTERY

(Power doppler)
STENOSIS VESSEL INTRA-ABDOMEN

Bilateral renal arteries stenosis

(angiography)

Right renal artery stenosis

(CT –angiography )
STENOSIS VESSELS INTRA-ABDOMEN
 STENOSIS OF ARTERY

Left renal artery :

Stenosis
junction aorta
VASCULAR ANATOMY OF LIMBS
UPPER LIMB
ANEURYSM