Preliminary communication
Low-dose Computed Tomography in a Pregnant Woman with a Ruptured Pseudoaneurysm of the Abdominal Aorta
Jelena Popić Ramač
; Clinical department of diagnostic and interventional radiology, University hospital Merkur, University of Zagreb , Zagreb, Croatia
Vinko Vidjak
; Clinical department of diagnostic and interventional radiology, University hospital Merkur, University of Zagreb , Zagreb, Croatia
Dinko Škegro
; Internal Clinic, University hospital Merkur, University of Zagreb, Zagreb, Croatia
Željko Duić
; University department for gynecology and obstetrics, University hospital Merkur, University of Zagreb, Zagreb, Croatia
Darko Blašković
; Clinical department of diagnostic and interventional radiology, University hospital Merkur, University of Zagreb , Zagreb, Croatia
Lidija Erdelez
; Clinic of surgery,University hospital Merkur, University of Zagreb, Zagreb, Croatia
Andrija Škopljanac-Mačina
; Clinic of surgery,University hospital Merkur, University of Zagreb, Zagreb, Croatia
Slaven Suknaić
; Clinic of surgery,University hospital Merkur, University of Zagreb, Zagreb, Croatia
Marko Slavica
; Clinical department of diagnostic and interventional radiology, University hospital Merkur, University of Zagreb , Zagreb, Croatia
Nikola Ivan Leder
; Clinical department of diagnostic and interventional radiology, University hospital Merkur, University of Zagreb , Zagreb, Croatia
Abstract
Imaging the pregnant patient presents a unique challenge to radiologist due to the risk of radiation to the conceptus (embryo/fetus). A rare case of a successfully recognized and treated pseudoaneurysm (PA) of the abdominal aorta is to be presented. The pseudoaneurysm occurred in the third trimester and had a favorable outcome for the mother and the baby. Emergent abdominal ultrasound (US) is the first modality in diagnostic algorithm for the rupture of aortic aneurysm in a pregnant woman. It provides the most rapid diagnostic information, although intestinal gas and abdominal tenderness may limit its accuracy. To confirm the findings, magnetic resonance angiography (MRA) or CT angiography (CTA) can be used. In our case, the diagnosis was established using a color Doppler ultrasonography of the abdomen and was later confirmed by a low dose CT scan of the abdominal aorta. MRA in such cases have some disadvantages. At many health centers, the monitoring of patients with acute ruptures is more difficult in the MR suite than at the CT scanner. MRA angiographic images are also subject to degradation by multiple artifacts, and the visualization of the distal vasculature is suboptimal and inferior to the one done by CTA. Due to fetal movements, a small quantity of fresh blood can be overlooked by MR. MRA is often not available on a 24-hours basis, and the time required for making a diagnosis can preclude the use of MRA in an unstable patient. For this reason, we used a low dose CTA protocol to confirm the diagnosis. Low dose scanning protocols in CT can obtain sufficient diagnostic information while reducing the risk of radiation. A particular focus is put on the outline of new concepts for dose management and optimization. We used new approaches based on tube current modulation. The birth was induced by an urgent Caesarean section followed by a resection of a pseudoaneurysm and a reconstruction of the aorta with an end-to- end vascular prosthesis
Keywords
PSAN-pseudoaneurysm; AA-abdominal aorta; low dose protocol; CT-computed tomography; radiation risk; CTA-CT angiography; MRA-magnetic resonance angiography
Hrčak ID:
166382
URI
Publication date:
20.11.2015.
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