Multi-Modality Imaging and Diagnosis of Aortic Fistulas

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.50
Procedures: 2.50
Abdomen and Pelvis: 2.50

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Body: 0.50

Nuclear Medicine Technology: 0.50
Procedures: 0.50
Other Imaging Procedures: 0.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Neurological, Vascular, and Lymphatic Sections: 2.50

Sonography: 0.50
Procedures: 0.50
Abdomen: 0.50

Vascular-Interventional Radiography: 0.50
Procedures: 0.50
Vascular Diagnostic Procedures: 0.50

Vascular Sonography: 0.50
Procedures: 0.50
Abdominal/Pelvic Vasculature: 0.50

Outline

1. Introduction
2. Pathogenesis of AoFs
3. Spectrum of AoFs
4. Radiologic Imaging
   1. CT Angiography
   2. Conventional Angiography
   3. MR Angiography
   4. Nuclear Imaging
   5. Ultrasonography
5. Principal Imaging Features
6. Aortoatrial Fistula
   1. Epidemiologic and Clinical Features
   2. Imaging Features
7. Aortopulmonary Fistula
   1. Epidemiologic and Clinical Features
   2. Imaging Features
8. Aortobronchial Fistula
   1. Epidemiologic and Clinical Features
   2. Imaging Features
9. Aortoesophageal Fistula
   1. Epidemiologic and Clinical Features
   2. Imaging Features
10. Aortoenteric Fistula
    1. Epidemiologic and Clinical Features
    2. Imaging Features
11. Aortocaval Fistula
    1. Epidemiologic and Clinical Features
    2. Imaging Features
12. Pitfalls
    1. Anatomic Mimics
    2. Postoperative Mimics
13. Pathologic Mimics
14. Treatment
15. Conclusion

Objectives

Upon completion of this course, students will:

1. recognize rare causes of aortic fistulas (AoFs)
2. be familiar with CT angiography for diagnosing AoFs
3. be familiar with the use of nuclear medicine for determining infections or slow intermittent bleeds
4. be familiar with the definition of a true aneurysm
5. be familiar with the pathophysiology of a secondary fistula
6. be familiar with the morphologic subtypes of secondary AEFs
7. recognize the risk factors for aorto-pulmonary fistulas
8. be familiar with the entities that comprise the majority of clinically relevant AoFs
9. be familiar with the concentration of IV contrast used on CT angiography
10. be familiar with the advantages of using conventional angiography for detecting bleeds
11. be familiar with the use of MR angiography for patients who cannot tolerate iodinated CT contrast material
12. identify nitinol-based endografts
13. be familiar with the use of ^99mTc HMPAO for detecting infections
14. be familiar with the use of ¹¹¹In WBCs for detecting infections
15. be familiar with the use of ultrasound for evaluating patients with AoFs
16. be familiar with the primary cause of AAFs
17. be familiar with the use of PET/CT for after recent aneurysm repair
18. be familiar with the complications associated with AAF
19. be familiar with the patient manifestations of AAF
20. be familiar with APFs
21. recognize the medical issues resulting from an APF
22. be familiar with the use of echocardiography for evaluating AoFs
23. be familiar with the childhood surgeries that may result in ABFs
24. be familiar with the frequency of ABFs that are diagnosed at autopsy
25. be familiar with AEsoFs
26. be familiar with the manifestations of AEsoFs
27. be familiar with the signs on CT associated with AEsoFs
28. be familiar with AEFs
29. be familiar with the manifestations of AEsoFs
30. be familiar with the common manifestations for AEFs
31. recognize the direct signs of AEF on CT angiography
32. recognize the image findings of ACF on CT angiography
33. be familiar with the anatomic variants of the aortic contour
34. be familiar with the anatomy of the aortic nipple
35. be familiar with the use of nuclear medicine for detecting subtle bleeds
36. be familiar with infections that mimic fistula on CT
37. be familiar with the pathologic processes that can simulate AoFs on CT imaging
38. be familiar with Erdheim-Chester disease
39. be familiar with open repair for AEFs
40. be familiar with traditional reference standards for open repair
41. be familiar with the complications of open repairs
42. be familiar with AHA guidelines for treatment of AEsoFs
43. be familiar with conservative approaches for treatment of small AAFs and ABFs