CT angiography of acute aortic syndrome in patients with chronic kidney disease

The term acute aortic syndrome (AAS) refers to a range of different entities, including dissection, intramural haematoma and penetrating atherosclerotic ulcer. Patients with chronic renal disease and particularly those with dominant polycystic kidney disease are susceptible to this pathology, given the underlying renal arteriopathy and hypertension. Imaging plays a crucial role in diagnosing, grading and guiding management of these patients, with computed tomography angiography (CTA) being on the frontline. Albeit of overlapping of imaging findings between these conditions, specific imaging characteristics help discriminate and guide treatment. Given the nephrotoxic contrast agent involved, tailored CTA protocols or alternative imaging modalities such as MRI or US are necessary in this patient population. This review article discusses the main imaging findings of entities found in the spectrum of AAS, as well as the appropriate use and protocol of imaging modalities, focusing on the appropriate use of nephrotoxic contrast agents, the preservation of renal function and maintenance of optimal diagnostic accuracy.