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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