MRA (Magnetic Resonance Angiogram) Thorax 71555

1.3.1.1 Gonzales Ralph, Nadler Paul L, “Chapter 2. Common Symptoms” (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2009: http://www.accessmedicine.com/content.aspx?aID=79

2.1.1.1 Patient stable and greater than one year since prior examination

2.1.1.2 Pain in chest or back

2.1.2.1 Arch or Descending Aorta > 3.5 cm diameter on CXR

2.1.2.2 Ascending Aorta > 4.5cm cm diameter on CXR

Thoracic aneurysms may involve one or more aortic segments (aortic root, ascending aorta, arch, or descending aorta) and are classified accordingly (Figure 1). Sixty percent of thoracic aortic aneurysms involve the aortic root and/or ascending aorta, 40% involve the descending aorta, 10% involve the arch, and 10% involve the thoracoabdominal aorta (with some involving >1 segment). The etiology, natural history, and treatment of thoracic aneurysms differ for each of these segments. Eric M. Isselbacher Thoracic and Abdominal Aortic Aneurysms Circulation 111: 816-828

Elefteriades John A, Olin Jeffrey W, Halperin Jonathan L, “Chapter 105. Diseases of the Aorta” (Chapter). Fuster V, O’Rourke RA, Walsh RA, Poole-Wilson P, Eds. King SB, Roberts R, Nash IS, Prystowsky EN, Assoc. Eds.: Hurst’s The Heart, 12th Edition: http://www.accessmedicine.com/content.aspx?aID=3075150.

Eli Atar, Alexander Belenky, Menashe Hadad, Ehud Ranany, Shlomo Baytner, and Gil N. Bachar MR Angiography for Abdominal and Thoracic Aortic Aneurysms: Assessment Before Endovascular Repair in Patients with Impaired Renal Function Am. J. Roentgenol., Feb 2006; 186: 386 – 393

Olsson, Stefan Thelin, Elisabeth Ståhle, Anders Ekbom, and Fredrik Granath Thoracic Aortic Aneurysm and Dissection: Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002 Circulation, Dec 2006; 114: 2611 – 2618

S. Iliceo, G. Ettorre, et al Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography Eur. Heart J., Jul 1984; 5: 545 – 555

2.2.6.1 ACR Appropriateness Criteria® Acute Chest Pain-Suspected Aortic Dissection 2008

2.2.6.2 A. Khan and Chandra K. Nair Clinical, Diagnostic, and Management Perspectives of Aortic Dissection Chest July 2002 122:311-328

2.2.6.3 Kersting-Sommerhoff, BA, Sechtem, UP, Fisher, MR, Higgins, CB MR imaging of congenital anomalies of the aortic arch Am. J. Roentgenol. 1987 149 9-13

2.2.6.4 Paul J. Arpasi, Kostaki G. Bis, Anil N. Shetty, Richard D. White, and Orlando P. Simonetti MR Angiography of the Thoracic Aorta with an Electrocardiographically Triggered Breath-Hold Contrast-enhanced Sequence RadioGraphics 2000 20: 107-120

2.2.6.5 Prince MR. Gadolinium-enhanced MR aortography. Radiology 1994; 191:155-164

2.2.6.6 Roche, Kevin J., Rivera, Rafael, Argilla, Michael, Fefferman, Nancy R., Pinkney, Lynne P., Rusinek, Henry, Genieser, Nancy B. Assessment of Vasculature Using Combined MRI and MR Angiography Am. J. Roentgenol. 2004 182: 861-866

2.2.6.7 Patel, Pawan D., Arora, Rohit R. Pathophysiology, diagnosis, and management of aortic dissection Therapeutic Advances in Cardiovascular Disease 2008 2: 439-468

2.2.6.8 G. Sutsch et al, Predictability of aortic dissection as a function of aortic diameter Eur. Heart J., Jan 1991; 12: 1247 – 1256

2.3.2.1 diminished or delayed femoral pulses (brachial-femoral delay), and

2.3.2.2 low or unobtainable arterial blood pressure in the lower extremities

Coarctation of the aorta is typically a discrete narrowing of the thoracic aorta just distal to the left subclavian artery. However, the constriction may be proximal to the left subclavian artery or rarely in the abdominal aorta. In some cases, coarctation presents as a long segment or a tubular hypoplasia

UpToDate 17.2 Clinical manifestations and diagnosis of coarctation of the aorta June 14, 2009

Hager, Alfred, et al Follow-up of Adults With Coarctation of the Aorta: Comparison of Helical CT and MRI, and Impact on Assessing Diameter Changes Chest 2004 126: 1169-1176

2.4.1.1 Sabiston Textbook of Surgery, 17th Edition (2004) Townsend et al, eds; pp1905-1907

2.5.1.1 Cough

2.5.1.2 Dyspnea, acute onset

2.5.1.3 Hemoptysis

2.5.1.4 Tachypnea

2.5.1.5 Pleuritic chest pain

2.5.2.1 Age over 65

2.5.2.2 Immobiliztion, Recent or Current

2.5.2.3 Known DVT or Pulmonary Embolus

2.5.2.4 Known Malignancy

2.5.2.5 Excess Estrogen State

2.5.3.1 Massimo Pistolesi Pulmonary CT Angiography in Patients Suspected of Having Pulmonary Embolism: Case Finding or Screening Procedure? Radiology August 2010 256:334-337;

2.5.3.2 Mark D. Mamlouk, Eric vanSonnenberg, Rishi Gosalia, David Drachman, Daniel Gridley, Jesus G. Zamora, Giovanna Casola, and Sanford Ornstein Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients Radiology August 2010 256:625-632

2.5.3.3 Patel S, Kazerooni EA. Helical CT for the evaluation of acute pulmonary embolism. AJR Am J Roentgenol 2005;185(1):135–149

2.5.3.4 Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354(22):2317–2327

2.5.3.5 Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005;352(17):1760–1768

5.1.2.1 Arch or Descending Aorta > 3.5 cm diameter on CXR

5.1.2.2 Ascending Aorta > 4.5cm cm diameter on CXR

5.1.4.1 Thoracic aneurysms may involve one or more aortic segments (aortic root, ascending aorta, arch, or descending aorta) and are classified accordingly (Figure 1). Sixty percent of thoracic aortic aneurysms involve the aortic root and/or ascending aorta, 40% involve the descending aorta, 10% involve the arch, and 10% involve the thoracoabdominal aorta (with some involving >1 segment). The etiology, natural history, and treatment of thoracic aneurysms differ for each of these segments. Eric M. Isselbacher Thoracic and Abdominal Aortic Aneurysms Circulation 111: 816-828

5.1.4.2 Elefteriades John A, Olin Jeffrey W, Halperin Jonathan L, “Chapter 105. Diseases of the Aorta” (Chapter). Fuster V, O’Rourke RA, Walsh RA, Poole-Wilson P, Eds. King SB, Roberts R, Nash IS, Prystowsky EN, Assoc. Eds.: Hurst’s The Heart, 12th Edition: http://www.accessmedicine.com/content.aspx?aID=3075150.

5.1.4.3 Eli Atar, Alexander Belenky, Menashe Hadad, Ehud Ranany, Shlomo Baytner, and Gil N. Bachar MR Angiography for Abdominal and Thoracic Aortic Aneurysms: Assessment Before Endovascular Repair in Patients with Impaired Renal Function Am. J. Roentgenol., Feb 2006; 186: 386 – 393.

5.1.4.4 Olsson, Stefan Thelin, Elisabeth Ståhle, Anders Ekbom, and Fredrik Granath Thoracic Aortic Aneurysm and Dissection: Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002 Circulation, Dec 2006; 114: 2611 – 2618

5.1.4.5 S. Iliceo, G. Ettorre, et al Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography Eur. Heart J., Jul 1984; 5: 545 – 555

5.2.2.1 diminished or delayed femoral pulses (brachial-femoral delay), and

5.2.2.2 low or unobtainable arterial blood pressure in the lower extremities

5.2.3.1 Coarctation of the aorta is typically a discrete narrowing of the thoracic aorta just distal to the left subclavian artery. However, the constriction may be proximal to the left subclavian artery or rarely in the abdominal aorta. In some cases, coarctation presents as a long segment or a tubular hypoplasia

5.2.3.2 UpToDate 17.2 Clinical manifestations and diagnosis of coarctation of the aorta June 14, 2009

5.2.3.3 Hager, Alfred, et al Follow-up of Adults With Coarctation of the Aorta: Comparison of Helical CT and MRI, and Impact on Assessing Diameter Changes Chest 2004 126: 1169-1176

5.3.1.1 Cough

5.3.1.2 Hemoptysis

5.3.1.3 Known DVT * by sonography

5.3.1.4 Pleuritic chest pain

5.3.1.5 Tachypnea

5.4.1.1 Yuh-Min Chen , Shuling Yang , Reury-Perng Perng , and Chun-Ming Tsai Superior Vena Cava Syndrome Revisited Jpn. J. Clin. Oncol. 25: 32-36

5.4.1.2 Sheth, Sheila, Ebert, Mark D., Fishman, Elliot K. Superior Vena Cava Obstruction Evaluation With MDCT Am. J. Roentgenol. 2010 194: W336-346