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The National CML Society partners with CML experts throughout the nation to answer your questions about all things CML.
The bone marrow aspiration (BMA) removes a small amount of bone marrow fluid and cells through a needle placed into the bone, generally the pelvic bone. The bone marrow biopsy (BMB) removes a small amount of bone and is done at the same time as the aspiration. Complications, although rare, but may include excessive bleeding at the collection site or infection.
As always, if you have any other questions regarding these procedures, feel encouraged to ask your doctor about what is suitable for your personal needs and treatment.
Enter your email address to subscribe to this blog and receive notifications of new posts by email. April 10, 2006The term Acute Aortic Syndrome (AAS) is used to describe three closely related emergency entities of the thoracic aorta: classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU). CT is the most accurate imaging modality for the initial diagnosis, differentiation and staging. Radiology department of the Academical Medical Centre, Amsterdam and the Rijnland Hospital, Leiderdorp, the Netherlands. A non-enhanced scan of the thoracic aorta is included for the detection of an intramural hematoma (IMH).
Contrast differences between arterial and venous phase can be helpful in differentiating true and false lumen.
The branches of the arch are visualized to evaluate the extend of dissection and awareness of possible neurological complications. Classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU) are distinct entities, but closely related. The main goal for the radiologist is not only to detect which entity is causing the clinical problem, but more importantly to differentiate between type A and B! The Acute Aortic Syndrome (AAS) is classified according to Stanford.Stanford Type A lesions involve the ascending aorta and aortic arch and may or may not involve the descending aorta.
Classic Aortic Dissection is the most common entity causing an acute aortic syndrome (70%). Type A mortality 1-2% per hour after onset of symptoms, total up to 90% non-treated, 40% when treated.

The true lumen is smaller, as the false lumen wedges around the true lumen due to permanent systolic pressure (so called Beak-sign). Thrombus material invariably is located in the false lumen, which enhances later than the true lumen. The true lumen usually is smaller as the false lumen wedges around the true lumen due to permanent systolic pressure.
The false lumen usually adheres to the outer curvature of the aortic arch, as is seen in this case. The figures on the left both show a type A dissection with clear entry points in the ascending aorta.
The true lumen is surrounded by the false lumen, which is bigger and wedges around the true lumen due to permanent systolic pressure. 2) dynamic = dissection flap hanging in front of ostium like a curtain (usually treated with fenestration). Provide information about tortuisity and calcifications of the iliac tract if endovascular procedures are being considered. When no end-organs are compromised and there is sufficient perfusion, dissection can be left alone.
This may persist for a long time without clinical consequence, as is seen in the patient on the left with follow-up of 2 years. Even the slightest amount of fluid in pericardium, mediastinum or pleural cavity is suggestive of rupture of the dissection.
The cases on the left show evident rupture, with presence of extensive hematoma in above mentioned locations. Note extreme hematothorax and hematomediastinum, causing shift of the mediastinum and compression on the pulmonary veins and even aorta.
5 days after initial presentation this patient complained of acute chest pain mimicking the earlier episode.
Re-examination showed recurrence of flow in the false lumen, locally contained, but with alarming adhering pleural effusion. The patient could not undergo surgical or endovascular repair for various reasons and was treated consevatively.
It can be difficult to differentiate an aneurysm with thrombus from a dissection with a thrombosed false lumen.

Note that the IMH does not spiral around the true lumen, like in classic AD, helping to differentiate both.
Essentially, this is not important, therapeutical decision will be made by whether this IMH is classified as Type A or Type B IMH! PAU is defined as an ulceration of an atheromatous plaque that has eroded the inner elastic layer of the aortic wall. Rarely rupture, yet worse prognosis due to extensive atherosclerosis which causes organfailure (e.g. However most patients have a poor prognosis because of generalized atherosclerosis leading to diffuse organ failure.
CT in Nontraumatic Acute Thoracic Aortic Disease: Typical and Atypical Features and Complications.
The frequency can vary from physician to physician but most can anticipate the procedure at the time of diagnosis and perhaps yearly or more frequently until a deep response is achieved and maintained over time.
At the three month test, if response has been acceptable, or beyond, patients may be able to go long term without having to have the procedure as frequently.
You may be given a sedative and a local anesthetic to ease any discomfort from the procedure. Based off of your history, TKI, and personalized treatment goals, they will best be able to answer any specific questions you may have.
Prognosis of Aortic Intramural Hematoma With and Without Penetrating Atherosclerotic Ulcer. For CML patients, biopsies or aspirations are used to identify the Philadelphia Chromosome, or the translocation of the ends of chromosomes 9 and 22. Frequency may increase if incremental peripheral blood tests indicate a failure to achieve response milestones, particularly during the first 18 months of therapy.
As stated above, frequency may increase if peripheral blood tests indicate a loss of response or failure to achieve and maintain response milestones.
It is not out of the question to ask for the procedure to be done under sedation, however, this should be discussed with your doctor well in advance of the day of the appointment.

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