Fusiform Arterial Enlargement

Fusiform Arterial Enlargement
Sheri L. Harder, MD
DIFFERENTIAL DIAGNOSIS
Common
  • Dolichoectasia
  • Atherosclerotic Fusiform Aneurysm
  • Nonaneurysmal Dissection
Less Common
  • Dissecting Aneurysm/Pseudoaneurysm
  • Vasculitis
  • Nonatherosclerotic Fusiform Aneurysm/Vasculopathy
    • Neurofibromatosis Type 1
    • Systemic Lupus Erythematosus
    • Ehlers-Danlos IV
    • Marfan Syndrome
Rare but Important
  • Giant “Serpentine” Aneurysm
  • Atypical Saccular Aneurysm
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
  • Ectasia = elongated/tortuous artery
  • Fusiform aneurysm
    • Long segment fusiform arterial dilatation
    • Can be acute (dissecting) or chronic (ASVD, nonatherosclerotic vasculopathy)
Helpful Clues for Common Diagnoses
  • Dolichoectasia
    • Dilated/elongated arteries ± slow flow
    • Vessel layers intact
    • Older patients
    • Most common manifestation of intracranial ASVD
    • Vertebrobasilar > internal carotid artery
    • Ectasia often extends into branches
  • Atherosclerotic Fusiform Aneurysm
    • Thick wall ± organized thrombus
    • Variable slow flow
  • Nonaneurysmal Dissection
    • Vertebral > basilar > internal carotid artery
    • Lacks changes of ASVD in other vessels
    • Can be spontaneous or traumatic
Helpful Clues for Less Common Diagnoses
  • Dissecting Aneurysm/Pseudoaneurysm
    • Focal arterial dilatation
    • Trauma = most common etiology
    • Next to hard/fixed structures (bone, dura)
  • Vasculitis
    • Involves multiple vessels
    • Alternating stenoses/dilatations
  • Nonatherosclerotic Fusiform Aneurysm/Vasculopathy
    • Younger patient; history of inherited vasculopathy, immune disorder
Helpful Clues for Rare Diagnoses
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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Fusiform Arterial Enlargement

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