Vascular Calcifications and Aneurysms



Vascular Calcifications and Aneurysms


Michael P. Federle, MD, FACR

Kathleen E. Jacobs, BA





Key Facts


Terminology



  • Arterial calcifications are usually indicative of atherosclerosis or diabetic vasculopathy


  • Venous calcifications are thrombi or result of venous (usually portal) hypertension


Imaging



  • Ring-like or “tram-track” linear densities in vessel walls



    • “Conduit” calcification (implies calcification in wall of hollow tube)


  • Iliac artery aneurysm



    • Substantial danger of rupture with diameter > 5 cm


  • Visceral artery aneurysms



    • Splenic: Most common visceral aneurysm (60%)


    • Danger of rupture if large, in pregnant patient, or in patient with advanced liver disease


    • May mimic pancreatic tumor


  • Renal artery aneurysm



    • May mimic hypervascular or hypovascular tumor


  • Phleboliths (“vein stones”)



    • More common in multiparous women


    • Below level of ureterovesical junction


    • Radiolucent center with smooth spherical outline


  • Portal venous calcification



    • Usually indicates chronic ↑ pressure (portal hypertension)


    • Portal vein aneurysm may mimic pancreatic or other abdominal mass


Top Differential Diagnoses



  • Ureteral calculus


  • Renal calculi


  • Mucinous cystic pancreatic tumor


  • Pancreatic islet cell tumors


  • Renal cell carcinoma






(Left) Radiograph in a 50-year-old woman with type 1 diabetes shows severe, diffuse calcification of the aortic walls image & medium-sized vessels, including the splenic image & renal arteries image. This pattern of long, continuous calcification (Mönckeberg) is almost pathognomonic of diabetic angiopathy. (Right) Pelvic radiograph in the same patient. Mönckeberg calcification image does not cause significant luminal narrowing, unlike atherosclerotic calcified plaques.






(Left) Plain radiograph shows a large, peripherally calcified pelvic mass image that raises concern for a possible neoplasm. (Right) Axial CECT in the same patient shows that the mass is a large iliac artery aneurysm. Note the enhancement image of a portion of the lumen and the unenhanced thrombus image.



TERMINOLOGY


Definitions



  • Arterial calcifications are usually indicative of atherosclerosis or diabetic vasculopathy


  • Venous calcifications are thrombi or result from venous (usually portal) hypertension


  • Aneurysm implies significant dilation of vessel lumen with intact endothelial lining



    • Pseudoaneurysm = dilated lumen without intact lining (e.g., result of arterial injury from trauma, pancreatitis, etc.)


IMAGING


General Features

Tags:
Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Vascular Calcifications and Aneurysms

Full access? Get Clinical Tree
Get Clinical Tree app for offline access