Aortic Bulge: A Possible Predictive Sign of Impending Aortoenteric Fistula. Academic Article uri icon

Overview

abstract

  • PURPOSE: The purpose of this study is to introduce the aortic bulge sign, a finding observed retrospectively on computed tomography prior to the acute presentation of aortoenteric fistula, and to determine its interobserver reliability. METHODS: Following research ethics board approval, all cases of aortoenteric fistula at our institution occurring from 2011-2015 were identified retrospectively. All previous computed tomography images of patients who eventually developed aortoenteric fistula were reviewed by a single observer for the presence of a potentially predictive finding of fistulization, the aortic bulge sign. These previous images were then combined with age and sex matched controls into a case bank. Eight radiology residents and staff were instructed in observing the aortic bulge sign. These observers then reviewed the case bank in a blinded analysis to determine the interobserver reliability of this finding. RESULTS: Fourteen cases of aortoenteric were identified. The average patient age was 70.71 years with a male-to-female ratio of 11:3. Eleven patients had previous computed tomography images available for review. With blinded analysis by multiple observers, the aortic bulge sign was identified with greater than 80% agreement in six of 11 cases (66.67%). Fleiss' kappa was calculated at k = 0.60 (95% confidence interval 0.50-0.69), corresponding to moderate-to-substantial interobserver agreement. CONCLUSIONS: The aortic bulge sign has been retrospectively identified as a promising computed tomography finding of eventual aortoenteric fistula prior to acute presentation. Further study is required to determine the diagnostic value of this sign.

publication date

  • March 25, 2019

Research

keywords

  • Aorta
  • Aortic Diseases
  • Digestive System Fistula
  • Tomography, X-Ray Computed
  • Vascular Fistula

Identity

Scopus Document Identifier

  • 85063140895

Digital Object Identifier (DOI)

  • 10.1016/j.carj.2018.10.012

PubMed ID

  • 30922788

Additional Document Info

volume

  • 70

issue

  • 2