Thoracic Aortic Aneurysms

Thoracic aortic aneurysms are aneurysms, or increased weakened areas within certain areas of the aorta. To be classified as a thoracic aortic aneurysm it can be located in the ascending, arch, or descending portion of the aorta. Patients with thoracic aortic aneurysms typically experience no symptoms. If they do experience symptoms they could be short of breath or have chest or back pain. When an aneurysm ruptures patients experience severe pain. Many patients die before they even reach a hospital for treatment. Success for treatment of ruptured aortic aneurysms is only about 50 percent. If aneurysms are detected prior to rupture blood pressure can be controlled, and regular checks of the size of the aneurysms are the first steps of treatment. Diagnosis is typically found by accident while imaging another body area, in patients that are having minimal or no symptoms. Resection or grafting can be done to prevent rupturing of the aneurysm, but are typically performed only when the size of the aneurysm has reached certain limits. CT imaging of a thoracic aortic aneurysm can be seen above.

Pars Fracture

Pars fractures, also know as pars defect, are fractures to the area of the vertebrae called the pars. The pars is in the posterior aspect of the vertebrae and connects the lamina and the transverse processes. Trauma or repeat injuries to the low back are what cause pars fractures. They are common in teens, especially gymnasts and football players. Commonly both pars are fractured, but it is possible that only one be fractured. Symptoms are low back pain, stiffness, tingling, numbness and weakness in the lower extremities. Diagnosis can be made in three ways, x-rays, CT scans, and nuclear medicine bone scans. Treatment starts with bracing and restricted activities. It symptoms persist, surgical treatment is necessary. Laminectomy and lumbar fusion are the two types of surgeries performed. A CT sagital image of an L5 pars fracture is shown above.

Thoracic Compression Fractures

Thoracic compression fractures are something that I am very familiar with because one of the radiologists that I work with regularly specializes in treatment of compression fractures. Compression fractures are when the vertebral body breaks and then collapses. This can occur in any vertebral body, but the thoracic spine is the most common area. It is typically caused by some sort of trauma to the spine, but can also be due to osteoporosis. Symptoms are severe back pain and kyphosis. Treatment varies depending on the severity of the fracture. Oral pain medication, bracing, physical therapy, osteoporosis treatment, and surgical procedures are all used as treatment. The surgical procedures are kyphoplasty and vertebroplasty. These surgeries treat the fracture by expanding the vertebral body with a balloon like device and then filling them with a form of hardening material that will work like a vertebral body. Typically other treatments are used along with surgical treatment. Surgery must be performed shortly after the fracture occurs or the body will start to repair the fracture on its own and surgery cannot be performed. Diagnosis is typically made with plain film x-ray but can also be better imaged on CT, and MRI. Included is a CT image of a thoracic compression fracture.

CHIARI MALFORMATION

Chiari malformation is a deformity affecting the cerebellum and upper area of the cervical. It is imaged well on MRIs of the cervical spine. Two of these images are shown to the left. Chiari malformation is a congenital defect that occurs when the cerebellar tonils extend below the foramen magnum and into the spinal canal. Many times this is not diagnosed until teenage years or adulthood. Symptoms can include headache, neck pain/tension, tingling in extremeties, vision problems, difficulty swallowing and dizziness. Symtoms typically increase with sneezing and coughing. Treatment can range from pain management to surgery. The surgery is called a posterior fossa decompression. Part of the skull is surgically removed to decrease the pressure on the brain stem. Surgical treatment is only used in extreme cases.

Carotid Artery Stenosis

Carotid artery stenosis, or disease, is due to a build up of plaque in the carotid artery. This build up causes a narrowing in the artery, which supplies blood to the brain. Many people do not realize that they have carotid artery stenosis until it is too late and they have a TIA or stroke. If caught early, carotid artery stenosis can be treated and preventive measures taken against stroke or TIA. These treatments can be oral prescriptions, life style changes, and/or surgical procedures. There are two type of surgical procedures, carotid endarterectomy and carotid artery stenting. Carotid artery stenting is when a stent is placed via catheter into the area of stenosis to open up the area and prevent complete clogging of the artery. Carotid endarterectomy is when the stenosed section of the artery is removed completely. Those that are at increased risk of carotid artery stenosis are those that drink, smoke, eat fatty and high in cholesterol foods, have diabetes, are older, are obese, are not physically active, or have a family history of the disease. Diagnosis can be made with MRA, CTA, carotid ultrasound, and cerebral angiography. Regular physicals are the best way to detect carotid artery stenosis before a stroke or TIA occurs. The image above is an MRA showing carotid artery stenosis.

Soft Tissue Neck Abscess

Soft tissue neck abscess occur in the spaces between the structures of the neck. An abscess is a collection of puss. The location of the abscess is how the name of the abscess is determined. They can be found behind the pharynx, beside the tonsils, and below the tongue. There are a variety of ways to diagnose, including blood tests, throat culture, biopsy, x-ray, and CT scans. The cause is due to infection, either bacterial or viral, in the area of the head and neck. The infection can spread, causing a pocket of infection to form and puss to grow. Symptoms of an abscess are fever, chills, body aches, swelling in the tongue and/or throat, difficulty swallowing, and difficulty breathing. Treatment depends on the location and cause but can be either antibiotic treatment or drainage of the abscess. A CT axial image of a retropharyngeal (located behind the pharynx) abscess is shown.

Sacular Aneurysm

Cerebral sacular aneurysms typically occur in the middle cerebral artery within the Circle of Willis. It is a ballooning of the artery that can be caused by a variety of things. It has been thought to be congenital, but recently this has been thought to be incorrect. It can also be caused by polycystic kidney disease, degenerative vascular disease, cocaine use, trauma, tumor, or infection. Symptoms range from none to headache, nausea, distorted vision, and loss of consciousness. MRI and MR Angiography can be used to diagnose sacular aneurysms. The image on the left is an MRA and the image of the right is an MRI FLAIR. Treatement involves surgical placement of coils or clips.