13:10 CET
BS 2 - Thoracic emergencies
Chest General Radiology
Wednesday, February 27, 10:30 - 12:00
Type of session: E³ - Rising Stars Programme: Basic Sessions
Topic: Chest, General Radiology
Moderator: A. P. Parkar (Bergen/NO)

10:30
Acute aortic syndrome
T. Jargiello; Lublin/PL
Learning Objectives

1. To become familiar with the most common aetiologies of acute aortic diseases.
2. To present current imaging techniques for evaluation of acute aortic diseases.
3. To demonstrate the most important imaging findings.

Abstract

Acute aortic syndrome (AAS) describes symptoms relevant to severe chest or back pain caused by several aortic pathologies which can be potentially life-threatening. The most common aetiology compromises the majority of AAS is aortic dissection. Other causes of AAS with similar presentation include intramural haematoma, penetrating aortic ulcer (atherosclerotic), aneurysm formation (rupture, enlargement) and traumatic transection (pseudoaneurysm). Imaging plays a vital role in diagnosing AAS. The role of the plain chest radiograph is nowadays historic. Echocardiography (plain or transoesophageal) is an effective portable tool but does not visualise the whole thoracic aorta. It may only suggest a certain AAS aetiology. Contrast-enhanced CT is now considered as the diagnostic method of choice. It provides an accurate aortic assessment as well as a detailed evaluation of other thoracic structures. CT permits 3D reconstructions, essential for intervention planning and it is widely available. Its sensitivity for aortic disorders reaches 100%. MRI is another imaging modality to diagnose AAS. Although it provides greater anatomical detail than CT, it is seriously limited. The limitation involves procedure time, lesser availability, and the expense.

11:00
Pulmonary embolism
C. Loewe; Vienna/AT
Learning Objectives

1. To review the most common pathologies leading to pulmonary embolism.
2. To present current imaging techniques for evaluation of pulmonary embolism.
3. To become familiar with the typical findings in acute and chronic pulmonary embolism.

Abstract

Pulmonary embolism (PE) represent a daily clinical challenge at the emergency department: out of the patients admitted to an emergency room because of the very unspecific clinical symptom of chest pain and/or dyspnea, the early identification of patients with a high clinical likelihood for PE is a difficult task. The D-Dimer test is very sensitive but unspecific for pulmonary embolism, and by using this test without clinical assessment, a high number of patients will be diagnosed as “false positives”. On the other hand, PE is potentially life-threatening; and early and safe diagnosis of this relevant disease is important to improve patient’s outcome. CT angiography of the pulmonary arteries has been established as the first method of choice to accurately detect PE with a high PPV and PPV. This presentation will provide an overview of the diagnostic challenges in the chest pain unit and will explain the need for accurate clinical assessment to select the right patient for the appropriate diagnostic test. Furthermore, the risks due to overdiagnosis or false-positive diagnosis will be exemplified. In the second part, this presentation will Focus on the Radiological view on this picture by explaining an optimised Imaging technique and possible pitfalls and problems. Challenging situations in the daily clinical practice will be discussed by addressing the role of imaging in suspected PE in pregnancy and the oncologic patients. Finally, typical findings in acute and chronic pulmonary embolism will be reviewed.

11:30
Acute coronary syndrome
R. M. M. Hinzpeter; Zurich/CH
Learning Objectives

1. To become familiar with segmental coronary anatomy.
2. To present different techniques for assessment of acute coronary syndrome.
3. To become familiar with the typical findings of acute coronary syndrome.

Abstract

Normal anatomic conditions of the coronary artery tree consist of two main coronary arteries, a left coronary artery and a right coronary artery arising from the coronary sinuses in the proximal ascending aorta immediately distal of the aortic valve. The right coronary artery descends in the right atrioventricular groove to the inferior surface of the heart, continuing as the posterior descending artery representing a right dominant circulation. After a short common stem, the left coronary artery bifurcates into the left anterior descending, coursing in the anterior interventricular groove and the left circumflex artery coursing in the left atrioventricular groove. After the initial workup of an acute coronary syndrome in the emergency department, including laboratory values and ECG changes, coronary CT angiography (CCTA) as a non-invasive examination plays an important role besides invasive techniques. Especially in patients with low to intermediate risk CCTA is a quick and reliable method for ruling out coronary artery disease with a very high negative predictive value in the absence of coronary artery calcifications. Besides the detection of significant coronary artery stenosis, the presence, amount and composition of non-calcified plaques and the degree of coronary remodelling is substantial. In addition, information about structural changes of the myocardium and myocardial perfusion can be obtained by CCTA.

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