![]() Sebastià C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A. Thrombosed false lumen in classic aortic dissection: typically spirals longitudinally around the aorta whereas an intramural hematoma usually maintains a constant circumferential relationship with the aortic wallĪortitis: typically shows concentric uniform thickening of the aortic wall with or without peri-aortic inflammatory stranding, whereas an intramural hematoma is often eccentric in configuration Untreated, an intramural hematoma can be life-threatening as it can lead to: Increase the thickness of the intramural hematoma at follow-up CTA Presence of ulcer-like projections (ULPs) Risk factors for progression of intramural hematoma and worse prognosis include 13: small region of contrast accumulation within the hematoma with invisible or small (90% at 5 years 7 It is important to distinguish between aortic dissection and acute intramural hematoma as they have different prognostic significance 11. On follow-up imaging, contrast can occasionally be seen within the intramural hematoma. Unlike aortic dissection, no intimal flap is present on the CTA. The lesions exhibit low attenuation in relation to the aortic lumen on post-contrast CT and can be far more subtle, hence a non-contrast phase before CTA is often done in an acute aortic syndrome protocol. Thickening is greater than the normal aortic wall thickness. Intimal calcification may be displaced inwards, best appreciated in the non-contrast phase. The narrow window width is essential for identifying subtle lesions 6. Radiographic features CTĪcute intramural hematomas appear as focal, crescentic, high-attenuating (60-70 HU) regions of eccentrically thickened aortic wall on non-contrast CT ( high-attenuation crescent sign). The DeBakey classification can also be used 5. Type B: confined to the descending aorta, distal to the origin of the left subclavian artery Type A: involves the ascending aorta, with or without descending aortic involvement Similar to aortic dissections, aortic intramural hematomas are classified according to the Stanford classification 4: There is a greater predilection to involve the descending aorta 13. Patients with aortic intramural hematoma and penetrating atherosclerotic ulcers have an increased risk of concomitant abdominal aortic aneurysm 13. aortic dissection) and/or hemopericardium 14. AssociationsĪcute intramural hematoma may coexist with other forms of acute aortic syndrome (e.g. Consequently, intramural hematoma weakens the aorta and may progress either to outward rupture of the aortic wall or to inward disruption of the intima, the latter leading to a communicating aortic dissection 2. The hematoma propagates along the medial layer of the aorta. Other theories describing the pathogenesis include thrombosis of a dissection lumen, microscopic intimal tears, progression from a penetrating atherosclerotic ulcer and traumatic medial injury 13. ![]() ![]() This condition is thought to begin with spontaneous rupture of the vasa vasorum, the blood vessels that penetrate the outer half of the aortic media from the adventitia and arborize within the media to supply the aortic wall 2. The clinical features of intramural hematoma are those of the acute aortic syndromes, namely chest pain radiating to the back and hypertension 14. Typically, aortic intramural hematomas are seen in elderly hypertensive patients. The same condition may also develop as a result of blunt chest trauma with aortic wall injury or a penetrating atherosclerotic ulcer 1,2.
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