...
Most patients with aortic aneurysms (AA) are asymptomatic at the time of diagnosis, because the aneurysms are typically discovered incidentally on imaging studies. When an AA reaches medium to large size (>5cm), symptoms may manifest.
Symptoms for TAA are: patients may suffer a local mass effect, such as compression of the trachea or mainstem bronchus (if in the area of the lungs, will cause cough, shortness of breath, wheezing, or recurrent pneumonitis), compression of the esophagus (causing dysphagia), or compression of the recurrent laryngeal nerve (causing hoarseness). Chest pain, generally described as deep and aching or throbbing.
Symptoms of AAA are: pain in the chest, abdomen, lower back, or flank (over the kidneys). A pulsating feeling in the abdomen. A "cold foot" or a black or blue painful toe.
When a patient has abdominal aortic aneurysm of a substantial size, the patient may also have synchronous and metachronous thoracic aortic aneurysm. If causes and conditions are present to create an aneurysm in a large-medium size vessel in one place, you are more likely than those without those causes and conditions to have (or develop) another aneurysm somewhere. The pressure from the medium to large aneurysm may also cause arterial dissection where the wall of the artery is tore, and a "false lumen" forms within the wall of the artery and blood can leak into it - leading to rupture.
Both examples below ask the following questions:
- Are AAA and TAA present? If yes, where are they? What is the diameter of the identified aneurysm?
- In the presence of large AAA and TAA, arterial dissection is likely. If arterial dissection is observed, where is it? can you classify the dissection based on anatomy?
The figure below describes the general process flow from when a patient complains about the symptoms indicative of TAA and AAA to the diagnosis of TAA and AAA, followed by their subsequent evaluations. This is a summary of all the data collected.
| Excerpt Include |
|---|
TAA and AAA concept map 1 | TAA and AAA concept map 1 | The concept map below transforms the general process figure above into CDISC-compliant format. Note the (TST) and (RES) prefixes are done intentional in the map to show: measurement (--TEST) location vs result (--ORRES) location, respectivelyThe patient had undergone a diagnostic intervention, during which a CT scan was done on the chest and abdomen of the subject. The CT scan created images of the thoracic and abdominal regions. An evaluator then reviewed the images of the thoracic region and abdominal region, to find whether aneurysms and arterial dissections are present and where they are located.
| Excerpt Include |
|---|
| TAA and AAA concept map 2 |
|---|
| TAA and AAA concept map 2 |
|---|
|
Case 1 - Subject has both TAA and AAA
The subject had CT scans performed on the chest and abdomen.
...
An evaluator examines the images of the thoracic and abdominal cavities regions produced by the CT scan and decides whether TAA and AAA are present as well as their location. Modeling both TAA and AAA in the CV domain, note for viewing simplicity, some variables are omitted from the table below.
| Dataset wrap |
|---|
|
| Rowcaps |
|---|
| Row 1: | I examined the image of the thoracic cavity region (test location) and found an aneurysm in the Thoracic Aorta (result location) spanning from the aortic arch to the descending aorta (result location detail). In this case the result location detail further qualifies both ORRES and RESLOC, hence this is a variable qualifier for RESLOC. |
|---|
| Row 2: | I measured the diameter of the aneurysm from aortic arch to the descending aorta (test location). |
|---|
| Row 3: | I examined the image of the thoracic cavity region (test location) and found that the descending aorta (result location) had severely dissected (the artery is tore and a false lumen had formed), most likely due to the enormous pressure caused by the large aneurysm in this area. |
|---|
| Row 4: | The dissected descending aorta (test location) is classified based on the Stanford Aortic Dissection System as type B. |
|---|
| Row 5: | I examined the image of the abdominal cavity region (test location) and found an aneurysm in the infrarenal aorta (result location), proximal to the iliac bifurcation (result location detail). In this case the result location detail is a variable qualifier for the result, I am trying to say that the aneurysm is located in the segment of the infrarenal aorta closer (proximal) to the iliac bifurcation. |
|---|
| Row 6: | I measured the diameter of the infrarenal aortic (test location) aneurysm. |
|---|
| Row 7: | I examined the image of the abdominal cavity region and found that the infrarenal aorta (result location) had dissected. |
|---|
|
| Dataset2 |
|---|
Row | STUDYID | DOMAIN | USUBJID | CVSEQ | CVGRPID | CVTEST | CVORRES | CVORRESU | CVLOC | CVLOCDTL | CVMETHOD | VISITNUM | VISIT | CVDTC |
| CVRESLOC
| CVRESLOC Detail |
|---|
| 1 | ABC | CV | ABC-123 | 1 | 1 | Aneurysm Indicator | Y |
| Thoracic Cavityregion |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
| Thoracic Aorta | Aortic Arch to Descending aorta |
|---|
| 2 | ABC | CV | ABC-123 | 2 | 1 | Aneurysm Diameter | 6 | cm | Thoracic Aorta | Aortic Arch to Descending aorta | CT SCAN | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
| 3 | ABC | CV | ABC-123 | 3 | 2 | Dissection Indicator | Y |
| Thoracic Cavityregion |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
| Descending aorta |
|
|---|
| 4 | ABC | CV | ABC-123 | 4 | 2 | Stanford AoD Classification | Stanford B |
| Descending aorta |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
| 5 | ABC | CV | ABC-123 | 5 | 3 | Aneurysm Indicator | Y |
| Abdominal Cavityregion |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
| Infrarenal aorta | proximal to the iliac bifurcation |
|---|
| 6 | ABC | CV | ABC-123 | 6 | 3 | Aneurysm Diameter | 7 | cm | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
| 7 | ABC | CV | ABC-123 | 7 |
| Dissection Indicator | Y |
| Abdominal Cavityregion |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
| Infrarenal aorta | proximal to the iliac bifurcation |
|---|
|
|
Case 2 - Subject has AAA but TAA is not found
The subject had a MRI performed on the upper bodytorso (trunk).
| Dataset wrap |
|---|
|
| Dataset2 |
|---|
Row | STUDYID | DOMAIN | USUBJID | PRSEQ | PRTRT | PRLOC | VISIT |
| PRLOC1 | PRLOC2 |
|---|
| 1 | ABC | PR | ABC-456 | 1 | MRI | UPPER BODYMultiple | BASELINE |
| Chest | Abdomen |
|---|
|
|
The MRI scan produced images about the thoracic and abdominal regions of the subject. The evaluator then examined the MRI images of the thoracic cavity region and abdominal cavityregion, and found the presence of a large AAA, but the absence of TAA.
| Dataset wrap |
|---|
|
| Rowcaps |
|---|
| Row 1: | I examined the MRI image of the thoracic cavity region (test location) and didn't find the presence of an aneurysm. |
|---|
| Row 2: | I examined the MRI image of the abdominal cavity region (test location) and found an aneurysm in the left (Result LAT) renal artery (Result Loc). |
|---|
| Row 3: | I examined the image of the abdominal cavity region (test location) and found an aneurysm in the infrarenal aorta (Result Loc). |
|---|
| Row 4: | I measured the diameter of the aneurysm in the left renal artery (test location). |
|---|
| Row 5: | I measured the diameter of the aneurysm in the Infrarenal Aorta (test location). |
|---|
|
| Dataset2 |
|---|
Row | STUDYID | DOMAIN | USUBJID | CVSEQ | CVGRPID | CVTEST | CVORRES | CVORRESU | CVLOC | CVLAT | CVMETHOD | VISITNUM | VISIT | CVDTC |
| CVRESLOC
| CVRESLAT |
|---|
| 1 | ABC | CV | ABC-456 | 1 |
| Aneurysm Indicator | N |
| Thoracic CavityRegion |
| CT SCANMRI | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
| 2 | ABC | CV | ABC-456 | 2 | 1 | Aneurysm Indicator | Y |
| Abdominal CavityRegion |
| CT SCANMRI | 1 | BASELINE | 2020-04-27 |
| Renal Artery | Left |
|---|
| 3 | ABC | CV | ABC-456 | 3 | 2 | Aneurysm Indicator | Y |
| Abdominal CavityRegion |
| CT SCANMRI | 1 | BASELINE | 2020-04-27 |
| Infrarenal Aorta |
|
|---|
| 54 | ABC | CV | ABC-456 | 54 | 1 | Aneurysm Diameter | 23 | cm | Renal Artery | Left | CT SCANMRI | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
| 65 | ABC | CV | ABC-456 | 65 | 2 | Aneurysm Diameter | 5 | cm | Infrarenal Aorta |
| CT SCANMRI | 1 | BASELINE | 2020-04-27 |
|
|
|
|---|
|
|