Help me analyze this CT Scan

[Duff Man]

I know most of you are not doctors and probably not cardiologists, but I have a serious question and I'm looking for your best logical analysis. My aneurysm isn't like anyone's I've seen. It has sharp angles, and it appears to be one sided. I believe that means there's signifant weakening in the one spot where it kind of looks like a beak. I think it MAY be worse than say someone with a 5 or 5.5 cm aneurysm just because it's been compromised in such a concentrated area. I'm thinking about it like a garden hose.

Please, venture a guess and tell me what you think about the integrity of this aneurysm given the odd shape, size and location.

 

[Ross]

That ain't no aorta man, that's an alien!

I don't know what to make of it actually. I suspect along the lines that you do, but I'm not a Doc.

 

[upchurch131]

Aaron,

Since the heart is not well defined, its hard to figure this out for me. My scan, as you probably saw, shows the ascending aorta with more defined, rounded walls rather than any bulges. But on the other side, I am sure if yur cardiologist or consulting surgeon saw the possibility of the wall thinning or blowing out, you'd have been in surgery already. But it is obvious that your plumbing is not right!

Did you get the scans from your doctor or are you reading them from a disk? I have the scans, but I can't read the 3D stuff- just the routine B/W CT images. Guess you need special software.

 

[Duff Man]

I'm pretty serious about this man, if you have a guess as to what kind of integrity this thing has I'd love to hear it.

Here's the weird bulge I was talking about highlighted:

it honestly looks like a small dissection to me:

 

[Duff Man]

@ Upchurch: I have the disk with the 3D and 2D/black&white scans. It lets me move all around the body like a cool special effects camera shot. I'm fortunate they had this technology or the bulge there wouldn't have been visualized very well on a slice only perspective. This is a "brilliance 64" ct scan by philips. I believe it's one of the best scanners out there right now.

 

[Susan BAV]

No doctor here, no expert, but it certainly looks strange to me, Aaron, as though there was a pinch or injury to the aortic tissue at one time? I recall a member here, Catwoman I think, whose husband had to get a valve replaced from a car accident which damaged his valve--but I don't recall any particulars such as what valve it was.

What is the definition for an aneurysm of that shape? Can you send that picture around to some surgeons via email and ask them what they think?

 

[ctyguy]

Aaron...I don't know if you have considered this already or not but Cleveland Clinic offers people the chance to get an opinion about their condition without going to the hospital. They need full copies of their records in order to make an evaluation. Thats basically what I did, when I contacted them I asked specifically for a surgeon (Gusta Pettersson) and they put me in touch with his office. I forwarded my medical history to him along with my EKG and Echo results. They reviewed, gave me their opinion about my condition, and said they would accept me as a surgical candidate before I even met him. Of course I had to go to C.C. after that conversation but it may be a good idea to get someone else to look at your CT Scan. Dr P is top notch and I have his contact info if your interested.

 

[Duff Man]

I've talked to 3 surgeons guys and each one has a totally different opinion. One says GO the other says NO until 5.5 and yet another says 4.8 which is probably where i'm at now anyway.

I'm just asking for your opinion on this as if it were a garden hose or a radiator hose or a pipe bong hose or whatever. If you could look at this and analyze the integrity of the bulge from a practical, logical perspective I would really appreciate it.

 

[ross3]

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I appreciate how you could feel concerned because it looks so different from the usual diagrams that are shown on the web etc.

I'd agree with those who are recommending getting more 'professional' input. I would think that you could get them to provide some explanation as to what's going on - beyond just a size only anaylsis.

Do you know what is the bump that is seen on the right side photo directly across from pointy area? Is this part of the aorta or just some sort of imaging artifact.

In your favor I note that the root of the aorta does not appear to be unduly enlarged.

 

[Duff Man]

Man I was hoping no one would say anything about the arch.

I'm thinking (and hoping) all he'll have to do is something like figure B in this drawing:

 

[aussigal]

Mine also had a bulge in one area which when seen on the echo you could see that that was the place where the blood was spurting against the wall of the ascending aorta therefore causing an aneurysm. Your bicuspid valve opens up like a cats eye and can therefore spurt the blood out at an angle instead of relatively straight down the middle of the aorta like a regular tricuspid valve. I spoke with my Cardio (who is a valve and echo specialist) he explained it to me. Hope this helps.

 

[Marty]

I know most of you are not doctors and probably not cardiologists, but I have a serious question and I'm looking for your best logical analysis. My aneurysm isn't like anyone's I've seen. It has sharp angles, and it appears to be one sided. I believe that means there's signifant weakening in the one spot where it kind of looks like a beak. I think it MAY be worse than say someone with a 5 or 5.5 cm aneurysm just because it's been compromised in such a concentrated area. I'm thinking about it like a garden hose.

Please, venture a guess and tell me what you think about the integrity of this aneurysm given the odd shape, size and location.

These are amazingly beautiful "reconstruction" images.You found great radiologists. Now its up to the vascular surgeons to figure out wht to do and when to do it. For years Dr. deBakey and his group in Houston were the world authorities. I think if these were my picures I might still consult them.

 

[Marguerite53]

I know nothing about your condition as mine was a simple bicuspid from birth valve replacement. But, listening to you here and there I wonder a few things.

Why is one surgeon saying wait. I mean, why? What is his reason? Are you on medication which might help things calm down for awhile? Is it your age and youthfulness he wants you to "enjoy" for as long as possible? Is there a potential for it coming back unless they wait long enough (like cataracts in the eye...they often make you wait...can't imagine this liklihood). I mean really....what!

And why would anyone want to trust the measurement of a machine (okay, a bitchin' good machine)? And 2 of the 3 surgeons think you're "there" already. What is the value of this 3rd surgeon and why are you hanging onto his evaluation? Is he your best choice? Are you in denial?

Will the truck that pulls in front of you and causes you to smash into a light pole and rupture the thing know that the measurement was still okay?? Aren't "things" at abit more at risk with you walking around with a seemingly fragile situation?

And then there's your emotional health. I know, you are intellectualizing that this whole thing is just a fascinating journey into the vast analytic depths of this machine we're calling your body. But that body houses your soul, and honest, we all know this...it's getting messed with big time. Suppressed fear is not healthy and we all had it!!! Thus the curse of the "waiting room". You will deny this anxiety...many of us do. And then when we get over to the other side of it and really relax, it's like oh, geez, was I ever stressed out!! So I just want you to honor those important emotional feelings also.

And then, just IMHO... your lovely wife. Where does she stand on all of this? How is she feeling about your waiting...about your going ahead...? I understand that she wants to have children....yours! Is is possible that this could just wait a wee bit longer, until you are not in this anxious mode, until the only thing you have to worry about is that wonderful possibility? Is she afraid and wants a part of you to remain? We need to quell her fears, then. You're gonna be fine. Look at all the many challenges our community has faced....still here.....yakking with you!!

You are anxious. You have a good, solid right to be! You are asking us things we cannot possibly know because you want to get your arms around this whole thing. Sure, there will be some comments which will enable you to ask better questions and learn things more completley. And you need to know enough so that you can advocate for you own best health. But there is a thresshold to this. You have to face the fact that you really can't ever learn all that you need to know to make these calls. And eventually, you have to "let go" and let them do their magic. And magic it will be. And you are the lucky recipient.

What's wrong with a summertime recovery? Sure beats walking in the snow!! What's wrong with conceiving a child in the wonder that is renewed life? Creating something fragile when you are no longer fragile, also.

So while those CT photos are absolutely amazing (I want one!!! Just going for a boring old 2 year check up echo today....I'm jealous!) all the answers in the book are not going to make the thing go away. It's kind of time to just pull in a nice long draw of air, shoulders back, chin up.......... get it done, Aaron.

Best wishes, really.

Marguerite

 

[pamela]

Hi Aaron, I'm going to be lazy here and not look up the posts where you told us the diameter of your new valve. Most of the literature I've read on aneurysms brings me to the conclusion that when it's twice the diameter of your baseline measurement, I'd go with the one taken at the root when they chose valve size, then it's the time to have it done. This opinion is formed only through the papers that I've read after clicking on a link given by other forum members and may not be the best source of info, but eh, it's what I've got. If I were in your shoes then the time for the dacron tube has long been here, my aortic valve and root are 21 mm and 23 mm respectively, that means 46mm would be pushing it for me.

The choice is yours and I only hope you have every chance to make a good one.

 

[Duff Man]

The smallest echo report I have in my possession measures my aorta at 31 mm. That was 4 years ago.

Something that a surgeon said to me in a letter that stuck out was that the aneurysm is "at least" 4.5 cm. I interpreted that as saying my aorta is shaped in a way that's hard to measure or quantify the risk of waiting, and that it probably has already grown.

I've been corresponding with a surgeon from the Debakey institute, Dr. Cos3lli.

Thanks for the analysis guys. If nothing else it's helping me realize I need it done and it's probably more dangerous to wait.

 

[Duff Man]

I believe my arch is ok. Yes, I measured everything and drew it for you. Yes, I'm a little obsessive... but I had to know if they're going to make an island out of my arch arteries. The arch has a similar diameter to the very base of the root. I made a measurement in green... if that's the aorta and people have been missing it, I need it done like yesterday.

 

[Duff Man]

Well, I respect your opinion, but I know I'm glad I didn't have to wait untill friday to know what I know now... I feel way more positive about the surgery because of that little bit of leg work, so even if I'm totally wrong at least I'll have a good week before I go back to doom and gloom. I was being facetious with the "cut here" dotted line... and just kind of venturing a guess as to where he'll do it.

 

[Duff Man]

I thought you were serious.

I'm totally LOL'ing right now. I thought you would laugh! I'm just a clown with MSpaint.. I wouldn't let me decide where the cut goes... but I do think it'll be very similar.

 

[Duff Man]

The aneurysm doesn't bother me as much as the shape of it. I looked closer at different angles/views of this thing and I feel like something is just not right above and beyond the aneurysm. I compared two different scans and both have the absence of contrast in the front of the ascending aorta. You can kind of see the outline of where the aorta truly is. I'm starting to think it might be a patent false lumen with thrombosis. I'm definitely going to ask about it this wednesday during my consult with a surgeon.


Again, this is just conjecture.... these images were taken 3 months apart, but both have that absence of contrast.

 

[deogloria]

Aaron, I'm with you on this one--that aorta looks totally wacked out to me. If that was mine, I'd get second and third opinions ASAP and be demanding surgery! But that's just my very uneducated opinion.

Of course, for all I know, mine might look like that, because I got the crappy CT scan that basically looks like a glorified x-ray...it took me an hour to FIND my aneurysm!

I don't know about the possibility of a dissection, but something just doesn't look right to me. Seriously...

But hopefully you're wrong and your aorta is just an "original."