Shah Amar, Zulfiqar Maria, Yano Motoyo
Department of Radiology, Mayo Clinic in Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
Abdom Radiol (NY). 2025 Feb;50(2):1029-1037. doi: 10.1007/s00261-024-04531-1. Epub 2024 Aug 30.
Luminal linear findings (LLF) of the abdominal aorta are often called aortic "flaps," triggering concern for acute aortic syndrome. However, these "flaps" are unlikely to represent intimomedial dissection given isolation to the abdominal aorta, short length, and incidental discovery. We aim to characterize the etiology and stability of LLF.
CT reports finalized January 2021-December 2022 were queried for terms "focal dissection," "dissection flap," "linear filling defect," and "linear flap." Patients were excluded for thoracoabdominal dissection, LLF in non-aortic vessel, no prior contrast-enhanced imaging, and less than 6 months between exams. Index exam reviewed for presence of LLF, atherosclerosis, and aortic caliber at LLF site. Prior exam assessed for aortic caliber and aortic findings at subsequent LLF site. Patients with unchanged LLF between exams were categorized "Stable" and patients with interval change "Dynamic."
Seven hundred and two cases identified. After exclusions, imaging from 70 patients reviewed; 1 excluded for no LLF. Stable Cohort of 39 patients had median follow-up 31 months (range 6-284 months). 87% of aortas were moderately/severely atherosclerotic (n = 16 moderate, n = 18 severe), while 69% were ectatic/aneurysmal (n = 27). Dynamic Cohort of 20 patients had median follow-up of 70 months (range 14-244 months). All were atherosclerotic and 80% were ectatic/aneurysmal compared to 25% ectatic/aneurysmal at prior imaging. Mural thrombus was present at the site of the future LLF in 17 of 20, thrombosed PAU in 1, and no focal findings in 2.
Short-segment LLFs within the abdominal aorta arise from prior mural thrombus and demonstrate long term stability. Clinically and radiographically indolent, LLFs should not be called dissection flaps.
腹主动脉的管腔内线性表现（LLF）常被称为主动脉“瓣片”，引发对急性主动脉综合征的担忧。然而，鉴于这些“瓣片”仅局限于腹主动脉、长度较短且为偶然发现，它们不太可能代表内膜中层剥离。我们旨在明确LLF的病因及稳定性。
查询2021年1月至2022年12月最终确定的CT报告中“局灶性剥离”“剥离瓣片”“线性充盈缺损”和“线性瓣片”等术语。排除患有胸腹主动脉剥离、非主动脉血管存在LLF、未进行过对比增强成像以及两次检查间隔少于6个月的患者。对索引检查进行评估，查看是否存在LLF、动脉粥样硬化以及LLF部位的主动脉管径。对之前的检查评估后续LLF部位的主动脉管径和主动脉表现。两次检查间LLF无变化的患者归类为“稳定”，有间隔变化的患者归类为“动态”。
共识别出702例病例。排除后，对70例患者的影像进行了复查；1例因无LLF被排除。39例稳定队列患者的中位随访时间为31个月（范围6 - 284个月）。87%的主动脉存在中度/重度动脉粥样硬化（n = 16例中度，n = 18例重度），而69%为扩张性/动脉瘤样（n = 27例）。20例动态队列患者的中位随访时间为70个月（范围14 - 244个月）。所有患者均有动脉粥样硬化，80%为扩张性/动脉瘤样，而之前影像检查时为25%。20例中有17例在未来LLF部位存在壁内血栓，1例为血栓形成的PAU，2例无局灶性表现。
腹主动脉内的短节段LLF源自先前的壁内血栓，并显示出长期稳定性。LLF在临床和影像学上表现不活跃，不应被称为剥离瓣片。
