Limited intimal tears (LIT) of the aorta or limited aortic intimal tears are subtle localized tears of the aortic intima without tear extension and represent an uncommon form of aortic dissection that can manifest as acute aortic syndrome 1-5.
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Epidemiology
Limited intimal tears are uncommon and account for approximately 5% of acute aortic syndromes 1,2.
Associations
Limited intimal tears can be associated with the following conditions 1-3:
vasculopathy (e.g. Behcet disease, IgG4 aortitis)
Diagnosis
The diagnosis of limited intimal tears can be conveniently established by CT angiography, due to a lower level of awareness for this entity and their smaller size they might be missed on imaging 1-3.
High-quality acquisitions and 3D rendering techniques might aid in the diagnosis 3.
Clinical presentation
Limited intimal tears can manifest as acute aortic syndrome and patients might complain of chest pain, neck pain, back pain or abdominal pain or present rarely with dyspnea hemoptysis or without symptoms 1-3. Some patients have hypotension or hypertension at the time of presentation 1.
Complications
Complications include 1-3:
limb ischemia or mesenteric ischemia
dissection propagation
Pathology
Pathological limited intimal tears are attributed to cystic media degeneration 1 without tear extensions.
They represent a class 3 aortic dissection tear type 2,5,6 and may have various appearances including linear or stellate as well as T-shaped and L-shaped variants 3.
Classification
Like other aortic syndromes or aortic dissection limited intimal tears should be classified according to their location and the involvement of the ascending aorta with the following classification systems 1-3:
Radiographic features
Echocardiography
The intimal tear might be detected on echocardiography as localized outpouching of the aortic wall 4.
CT
CT angiography may show the following 1:
linear or stellate as well as T-shaped and L-shaped luminal contour abnormalities
undermined tear edges or focal flaps
aortic bulge (outpouching of the residual aortic wall)
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associated findings and complications
mediastinal hematoma
esophageal abnormalities
Radiology report
The radiology report should contain the following 1:
description and location
type of the lesion
associated intramural hematoma
associated extracardiac findings and complications
Treatment and prognosis
Management is similar to other acute aortic syndromes. Stanford type A lesions should be considered for urgent surgical repair 1,2. In the absence of major complications, Stanford type B limited intimal tears can be managed medically 1. Overall prognosis seems to be similar as in classic dissection, intramural hematomas and penetrating aortic ulcers.
History and etymology
Limited intimal tears of the aorta were first described by the American pathologists Charles A Murray and Jesse Efrem Edwards in 1973 as ‘incomplete dissecting aneurysms’ 7.
Differential diagnosis
Differential diagnoses of limited intimal tears on imaging include other types of aortic syndromes especially 3:
penetrating aortic ulcer: associated arteriosclerosis changes
classic aortic dissections