Çok Kesitli Bilgisayarlı Tomografi İle Torakal Aortik Varyasyonlarının Değerlendirilmesi

Abstract

Amaç: Bu çalışmada çok kesitli bilgisayarlı tomografi (ÇKBT) ile torakal aortik varyasyonları ve görülme sıklığını değerlendirmeyi amaçladık. Gereç ve yöntem: Hastanemiz Radyoloji Ünitesinde Ocak 2016-Mart 2019 tarihleri arasında çekilen 2978 kontrastlı toraks bilgisayarlı tomografi tetkiki torakal aortik varyasyon varlığı, varyasyonların cinsiyet farklılığı yönünden retrospektif olarak değerlendirildi. Bulgular: Çalışmamızda torakal aortik varyasyonu görülme oranı %22.5 olup bu oran kadınlarda %25.76, erkeklerde %20.63 idi. En sık görülen torakal aortik varyasyon trunkus brakiosefalikus ile sol ana karotis arter aortadan ortak kökten orjin almasıdır (Bovine arkı). Görülme oranı % 13.76 idi. Diğer görülen varyasyonlar izole sol vertebral arterin aortadan çıkması, arkus aorta aberran sağ subklavyen arter (ARSA) varyasyonu, sağ arkus aorta ve aort koarktasyonudur. Bu varyasyonlara eşlik eden ikincil varyasyon ise sol vertebral aortanın arkus aortada orjin almasıdır. Kadın-erkek oranı açısından bakıldığında bovine arkı ve sağ arkus aorta varyasyonunda istatiksel olarak anlamlı fark izlenmiş olup diğer varyasyonlarda anlamlı fark izlenmedi. Sonuç: Torakal aortik varyasyonlar çoğunlukla asemptomatik olup bazı tipleri semptomatiktir. Bu varyasyonların görüntüleme özelliklerine aşina olmak, doğru tanı ve sınıflandırma ve cerrahi tedaviye rehberlik etme açısından önemlidir. Kontrastlı ÇKBT noninvaziv bir görüntüleme yöntemi olup, bu varyasyonların kapsamlı bir değerlendirmesini sağlamaktadır.

Keywords

• Torasik Aorta Anomalileri
• Komplet Vasküler Halka
• Çok Kesitli Bilgisayarlı Tomografi

Evaluation of Thoracic Aortic Variations by Multi-Slice Computed Tomography

Abstract

Objective: In this study, we aimed to evaluate the thoracic aorta variations and their incidence with multidedector computed tomography (MDCT). Materials and methods: Two thousand nine hundred seventy-eight contrast-enhanced thorax computed tomography examinations taken in the Radiology Unit of our hospital between January 2016 and March 2019 were retrospectively evaluated in terms of the presence of thoracic aortic variation and gender differences of the variations. Results: In our study, the incidence of thoracic aortic variation was 22.5%, this rate was 25.76% in women and 20.63% in men. The most common thoracic aorta variation was originating from the common root of the truncus brachiocephalicus and left common carotid artery aorta (Bovine arc). The incidence rate was 13.76%. Other observed variations were the origin of the isolated left vertebral artery from the aorta, aberrant right subclavian artery (ARSA) variation in the aortic arch, right aortic arch and aortic coarctation. The secondary variation accompanying these variations was the origin of the left vertebral aorta in the aortic arch. In terms of female-early ratio, a statistically significant difference was observed in the bovine arc and right aortic arch variation, but no significant difference was observed in other variations. Conclusion: Thoracic aortic variations are mostly asymptomatic and some types are symptomatic. Familiarity with the imaging features of these variations is important for accurate diagnosis and classification, and to guide surgical treatment. Contrast-enhanced MDCT is a non-invasive imaging method, providing a comprehensive evaluation of these variations.

Keywords

• Thoracic Aorta Anomalies
• Complete Vascular Ring
• Multi-slice Computed Tomography

References

1. Adachi B. Das arterien system der Japaner. Vol. 1. Kenkyusha, Kyoto; 1928. pp. 29-41.
2. Ergun E, Şimşek B, Koşar PN, Yılmaz BK, Turgut AT. Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance. Surg Radiol Anat 2013;35:503-9. https://doi.org/10.1007/s00276-012-1063-3
3. Kau T, Sinzig M, Gasser J, Lesnik G, Rabitsch E, Celedin S, et al. Aortic development and anomalies. Semin Intervent Radiol; 2007;24:141-52. https://doi.org/10.1055/s-2007-980040.
4. Edwards JE. Anomalies of the derivatives of the aortic arch system. Med Clin of North Am. 1948;32(4):925-49. https://doi.org/10.1016/s0025-7125(16)35662-0.
5. Rosen RD, Bordoni B. Embryology, Aortic Arch. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Mar 30.
6. Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010;65(6):481-7. https://doi.org/10.1016/j.crad.2010.02.003.
7. Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat 2009;31:319-23. https://doi.org/10.1007/s00276-008-0442-2
8. Backer CL, Ilbawi MN, Idriss FS, DeLeon SY. Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg 1989;97:725-31. https://doi.org/10.1016/S0022-5223(19)34517-9

9. Williams GD, Edmonds HW. Variations in the arrangement of the branches arising from the aortic arch in American whites and negroes (A second study). The Anat Rec 2005;62:139-46. https://doi.org/10.1002/ar.1090620203
10. Karacan A, Türkvatan A, Karacan K. Anatomical variations of aortic arch branching: evaluation with computed tomographic angiography. Cardiol Young 2014;24:485-93. https://doi.org/10.1017/S1047951113000656.
11. Ergun O, Tatar IG, Birgi E, Durmaz HA, Akçalar S, Kurt A, et al. Arkus aorta anatomisinin ve dallanma paternindeki varyasyonların anjiyografik olarak değerlendirilmesi. Turk Kardiyol Dern Ars. 2015;43(3):219-26. https://doi.org/10.5543/tkda.2015.49879.
12. Celikyay ZR, Koner AE, Celikyay F, Denız C, Acu B, Firat MM. Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging 2013;37:1011-9. https://doi.org/10.1016/j.clinimag.2013.07.008.
13. Agarwala BN, Bacha E, Cao Q, Hijazi ZM, Fulton D, Connolly H, et al. Clinical manifestations and diagnosis of coarctation of the aorta. In: UpToDate. 21 December 2011. Accessed 9 May2014. www.uptodate. com/contentssearch?search=&x=14&y = 8.
14. Thankavel PP, Brown PS, Lemler MS. Left-dominant double aortic arch in critical pulmonary stenosis and ventricular septal defect. Pediatr Cardiol. 2012;33(8):1469-71. https://doi.org/10.1007/s00246-012-0437-y
15. Faistauer Â, Torres FS, Faccin CS. Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum. Radiol Bras. 2016;49(4):264-6. https://doi.org/10.1590/0100-3984.2013.1934.
16. Dasari TW, Paliotta M. Cervical aortic arch. N Engl J Med. 2014;371(26):e38. https://doi.org/10.1056/NEJMicm1400771
17. Karkoulias KP, Efremidis GK, Tsiamita MS, Trakada GP, Prodromakis EN, Nousi ED, et al. Abnormal origin of the left common carotid artery by innominate artery: a case of enlargement mediastinum. Monaldi Arch Chest Dis 2003;59:222-3.
18. Komiyama M, Morikawa T, Nakajima H, Nishikawa M, Yasui T. High incidence of arterial dissection associated with left vertebral artery of aortic origin. Neurol Med Chir (Tokyo) 2001;41:8-11. https://doi.org/10.2176/nmc.41.8
19. Chadha NK, Chiti-Batelli S. Tracheostomy reveals a rare aberrant right subclavian artery; a case report. BMC Ear Nose Throat Disord 2004;4:1. https://doi.org/10.1186/1472-6815-4-1
20. Özkaya Ş, Şengül B, Hamsici S, Fındık S. An unusual cause of dyspnea. J Asthma 2010;47:946-8. https://doi.org/10.3109/02770903.2010.504877
21. Raymond GS, Miller RM, Müller NL, Logan PM. Congenital thoracic lesions that mimic neoplastic disease on chest radiographs of adults. Am J Roentgenol 1997;168:763-9. https://doi.org/10.2214/ajr.168.3.9057531
22. Aboulhoda BE, Ahmed RK, Awad AS. Clinically-relevant morphometric parameters and anatomical variations of the aortic arch branching pattern. Surg Radiol Anat. 2019;41(7):731-44. https://doi.org/10.1007/s00276-019-02215-w