Aneurysms in the aorta are classified based on their anatomical locations. Largely, they can be divided into two classes: thoracic aortic aneurysm (TAA), those that are in the thoracic aorta, and abdominal aortic aneurysm (AAA), those that are in the abdominal aorta.
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Thoracic aortic aneurysm (TAA) can further be divided into:
- Aortic root aneurysm
There are many types of Aortic Aneurysms, the two major types are:
- TAA: thoracic aortic aneurysm, may further be sub-classified based on location:
- Ascending aortic aneurysm
- Aortic arch aneurysm
- Descending aortic aneurysm
- Aneurysm that straddles multiple portions of the aorta (i.e. from aortic arch to descending aorta)
- AAA: abdominal aortic aneurysm, may further be:
- Above the renal artery
- Below the renal artery
- In the renal artery
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Abdominal aortic aneurysm (AAA) can be classified as:
- Suprarenal aortic aneurysm: above the kidneys
- Infrarenal aortic aneurysm: below the kidneys.
- Others: Pararenal, Jaxtarenal aortic aneurys.
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.
The 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.
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| TAA and AAA concept map 2 |
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| TAA and AAA concept map 2 |
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You don’t know if someone has aortic aneurysms. You may do screening tests based on family history. Sometimes, some symptoms may be experienced such as back pain, chest pain, pain in the lower abdomen that may be indicative of aortic aneurysm. If someone does have TAA, the possibility of synchronous and metachronous TAAs may be present. So you look at both chest and abdomen. If AAA is present but TAA is not, you make a note too.Case 1 - Subject has both TAA and AAA
The subject had CT scans performed at on the chest and abdomen to look for the presence of aneurysms, if there are any:.
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Row | STUDYID | DOMAIN | USUBJID | PRSEQ | PRTRT | PRLOC | VISIT |
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| 1 | ABC | PR | ABC-123 | 1 | CT SCAN | CHEST | BASELINE |
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| 2 | ABC | PR | ABC-123 | 2 | CT SCAN | ABDOMEN | BASELINE |
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An evaluator examines the images of the thoracic and abdominal 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.
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| Row 1: | I examined the image of the thoracic 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 result location detail further qualifies both ORRES and RESLOC, hence this is a variable qualifier. |
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| Row 2: | I measured the diameter of the aneurysm from aortic arch to the descending aorta (test location). |
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| Row 3: | I examined the image of the thoracic 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. |
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| Row 4: | The dissected descending aorta (test location) is classified based on the Stanford Aortic Dissection System as type B. |
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| Row 5: | I examined the image of the abdominal region (test location) and found an aneurysm in the infrarenal aorta (result location), proximal to the iliac bifurcation (result location detail). In this case 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. |
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| Row 6: | I measured the diameter of the infrarenal aortic (test location) aneurysm. |
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| Row 7: | I examined the image of the abdominal region and found that the infrarenal aorta (result location) had dissected. |
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Row | STUDYID | DOMAIN | USUBJID | CVSEQ | CVGRPID | CVTEST | CVTSTDTL | CVORRES | CVORRESUCVORRESU | CVLOC | CVLOCDTL | CVMETHOD | VISITNUM | VISIT | CVDTC |
| CVRESLOC
| CVRESLOC Detail |
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| 1 | ABCABC | CVCV | ABCABC-123 | 11 | 1 | Aneurysm Indicator | YY |
| Thoracic Cavityregion |
| CT SCAN | 1 | BASELINE | 20202020-04-27 |
| Thoracic Aorta | Aortic Arch to Descending aortaDescending Aorta |
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| 2 | ABCABC | CVCV | ABCABC-123 | 22 | 1 | Aneurysm Diameter | 6 | 8cm | mmThoracic Aorta | Aortic Arch to Descending Aortaaorta | CT SCAN | 1 | BASELINE | 20202020-04-27 |
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| 3 | ABCABC | CVCV | ABCABC-123 | 31 | Aneurysm Size | Interpretation | Medium | Descending Aorta | CT SCAN | 1 | BASELINE | 2020-04-27 | 4 | ABC | CV | ABC-123 | 4 | 2 | Dissection Indicator | Y |
| Thoracic Cavityregion |
| CT SCAN | 1 | BASELINE | 20202020-04-27 |
| Descending Aortaaorta |
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| 54 | ABCABC | CVCV | ABCABC-123 | 5 | 2 | DeBakey AoD Classification | Type III | Descending Aorta | CT SCAN | 1 | BASELINE | 2020-04-27 | 4 | 6 | ABC | CV | ABC-123 | 6 | 2 | Stanford AoD Classification | Stanford B |
| Descending Aortaaorta |
| CT SCAN | 1 | BASELINE | 20202020-04-27 |
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| 75 | ABCABC | CVCV | ABCABC-123 | 75 | 3 | Aneurysm Indicator | YY |
| Abdominal Cavityregion |
| CT SCAN | 1 | BASELINE | 20202020-04-27 |
| Infrarenal aorta | proximal to the iliac bifurcation |
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| 86 | ABCABC | CVCV | ABCABC-123 | 86 | 3 | Aneurysm Diameter | 137 | mmcm | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 20202020-04-27 |
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| 97 | ABCABC | CVCV | ABCABC-123 | 97 |
| 3Dissection Indicator | Aneurysm Size | Interpretation | Large | Y |
| Abdominal regionInfrarenal aorta |
| CT SCAN | 1 | BASELINE | 20202020-04-27 | 10 | ABC | CV | ABC-123 | 10 | 4 | Dissection Indicator | Y | Abdominal Cavity |
| Infrarenal aorta | proximal to the iliac bifurcation |
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Case 2 - Subject has AAA but TAA is not found
The subject had CT scans a MRI performed at the chest and abdomen to look for the presence of aneurysms, if there are any:on the torso (trunk).
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Row | STUDYID | DOMAIN | USUBJID | PRSEQ | PRTRT | PRLOC | VISIT |
| PRLOC1 | PRLOC2 |
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| 1 | ABC | PR | ABC-456 | 1 | CT SCANMRI | CHESTMultiple | BASELINE | 2
| Chest | ABC | PR | ABC-456 | 2 | CT SCAN | ABDOMEN | BASELINE | Abdomen |
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The MRI scan produced images about the thoracic and abdominal regions of the subject. The evaluator then examined the MRI images of the thoracic region and abdominal region, and found the presence of a large AAA, but the absence of TAAIf I were to model this in CV, I could show that AAA is detected along with its diameter measurement. On top of that, TAA is not detected.
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| Row 1: | I examined the MRI image of the thoracic region (test location) and didn't find the presence of an aneurysm. |
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| Row 2: | I examined the MRI image of the abdominal region (test location) and found an aneurysm in the left (Result LAT) renal artery (Result Loc). |
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| Row 3: | I examined the image of the abdominal region (test location) and found an aneurysm in the infrarenal aorta (Result Loc). |
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| Row 4: | I measured the diameter of the aneurysm in the left renal artery (test location). |
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| Row 5: | I measured the diameter of the aneurysm in the Infrarenal Aorta (test location). |
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Row | STUDYID | DOMAIN | USUBJID | CVSEQ | CVGRPID | CVTEST | CVORRES |
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CVORRESUCVLOCDTL | CVMETHOD | VISITNUM | VISIT | CVDTC |
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CV RES LOC
| CV RES LAT | CV Result LOC detail | 1 | ABC | CV | ABC-456 | 1 | 1 | Aneurysm Indicator | Y | abdominal cavity | CT SCAN |
| CVRESLOC
| CVRESLAT |
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| 1 | ABC | CV | ABC-456 | 1 |
| Aneurysm Indicator | N |
| Thoracic Region |
| MRI | 1 | BASELINE | 2020-04-27 |
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| 2 | ABC | CV | ABC-456 | 2 | 1 | Aneurysm Indicator | Y |
| Abdominal Region |
| MRI | 1 | BASELINE | 2020-04-27 |
| Renal Artery | Left |
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| 3 | ABC | CV | ABC-456 | 3 | 2 | Aneurysm Indicator | Y |
| Abdominal Region |
| MRI | 1 | BASELINE |
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2020 artery (Below the kidneys) 2 | ABC | CV | ABC 2 Length/2CMabdominal cavity | Infrarenal artery (Below the kidneys) | CT SCAN 2020 3 ABC CV 1 Indicator Nthoracic cavity | CT SCAN 2020
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