Aortic Aneurysms 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.
TAA can further be divided into:
Aortic root aneurysm
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 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.
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, dyspnea, 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, 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?
Case 1 - Subject has both TAA and AAA
The subject had CT scans performed at the chest and abdomen.
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STUDYID
DOMAIN
USUBJID
PRSEQ
PRTRT
PRLOC
VISIT
1
ABC
PR
ABC-123
1
CT SCAN
CHEST
BASELINE
2
ABC
PR
ABC-123
2
CT SCAN
ABDOMEN
BASELINE
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Modeling both TAA and AAA in the CV domain, note for viewing simplicity, some variables are omitted from the table below.
Row 1:
I examined the image of the thoracic cavity (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 is a variable qualifier.
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 (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 of 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 (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, 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 and found out that the infrarenal aorta (result location) had dissected.