0:00

Let's take a look at this lung cancer screening exam.

0:03

We've got soft tissue windows on the right

0:05

and our lung windows on the left.

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Again, as commonly seen, we have a lot

0:10

of upper lobe predominance.

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Central ular emphysema moderate to severe starts

0:16

to peter out gradually as we extend towards the lung basis.

0:19

But I don't think we have any normal area of lung tissue.

0:22

There's still emphysema in the lower lobes.

0:25

We see scattered areas of linear parenchymal scar,

0:28

which may be the result of prior episodes

0:31

of infection or inflammation.

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And we see some tiny nodules.

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A number of these sub four millimeter nodules like this one

0:38

as we scroll throughout the lungs.

0:40

Here's another one. We see a number of these.

0:42

They are under the size threshold

0:44

for calling them a positive screen

0:46

and remain at the lung rads two category.

0:49

And then we turn our attention to the soft tissue windows

0:52

and we can look for aortic calcification.

0:56

Coronary art trail calcification.

0:58

This patient has severe left main, left anterior descending

1:02

and circumflex territory calcification

1:05

here in the left AV groove

1:08

and overlying the ventricular septum.

1:10

Here on the left they have some lipoma hypertrophy

1:14

of the atrial septum and increase epicardial fat

1:17

and increase recognized risk factor

1:20

for cardiovascular disease.

1:23

And as we scroll up, the ascent aorta looks nice

1:27

and tubular round we see the aortic arch

1:30

branch vessels coming off

1:32

as we run down the de descend aorta.

1:34

It's looking nice and round in tubular.

1:37

And then right here it seems to either cross the mediastinum

1:41

or have a focal outpouching.

1:43

And as we scroll down it gets back to normal

1:46

and round in pretty short order.

1:48

So it looks, there's a focal contour de formity

1:50

to the descending aorta

1:52

and we see a lot of atherosclerotic

1:54

calcification at that location.

1:57

We can look at that in other planes.

1:59

And here we see, ooh,

2:00

there's a descending aorta, it's normal.

2:03

And tubular below we have this focal contour deformity

2:07

and it's normal diameter above it.

2:09

So we have a fo dilated descending aorta.

2:13

So be typical of a atherosclerotic ular aneurysm.

2:18

Often seen with penetrating atherosclerotic ulcer disease

2:21

as a sequela of plaque ulceration

2:24

and weakening of aortic wall that leads to a focal sac.

2:28

Atherosclerotic aneurysm.

2:30

Most atherosclerotic aneurysms

2:32

of the thoracic UTA are fusiform dilatation

2:35

where the entire segment of the ata, the ascending

2:38

or the descending or part of the descending is dilated.

2:41

Focal aneurysms are relatively uncommon.

2:44

So here we have a significant S modifier finding from lung

2:48

rats, uh, ular aneurysm of the descending UTA unsuspected.

2:53

This patient has had it followed over time.

2:57

This was a more recent

2:59

CT aortic gram

3:02

and we can see our great vessels coming off.

3:05

Aortic arch. Aortic arch see a lot of atherosclerotic,

3:09

calcified and noncalcified plaque

3:11

and the de descending aorta.

3:13

And as we come to that area of contour deformity, we can see

3:16

where there's a contrast outpouching.

3:18

And then there is, um, an area of either noncalcified plaque

3:23

and or thrombus.

3:25

You can see that much better here.

3:27

Let's look at those coronal images again, right here,

3:31

this focal out pouching, which matches exactly to the area

3:36

of the out pouch.

3:38

And we saw on the non-contrast chest ct, I think you,

3:41

you have to be extra attuned

3:42

to pick up these focal dilatations of the aorta on a noisy

3:47

non-contrast lung cancer screening ct.

3:50

But you could see it quite well here.

3:51

The patient was recommended to cardiac surgery.

3:55

Potentially this patient could qualify

3:57

for a covered stent graft

3:58

or an endovascular repair of the short segments.

4:01

And they have been following this serially over time.

4:05

It measured about 40 millimeters at the time

4:07

that it was detected on the lung cancer screening exam.

4:10

And at this point, they're choosing to seriously follow it

4:13

to understand its growth rate over time.

4:15

It looks like it's been stable for a couple years now,

4:18

but they will continue to follow it to make sure that

4:20

that is indeed the case

4:21

and that it does not expand over time

4:24

as these are at increased risk of rupture.