Aortic intramural hematoma

Case contributed by RMH Core Conditions


48 hours of thoracic / upper abdominal pain associated with shortness of breath post direct current cardioversion.

Patient Data

Age: 90 years
Gender: Male

There is mural thickening of the aorta extending from the arch (at the origin of the subclavian artery) to just above the renal artery. This is predominantly along the superior wall of the arch and along the left posterolateral aspect in the thoracic descending aorta. The mural thickening is high density on the precontrast images. 

There are pockets of contrast at various points within the mural thickening. A discrete intimal flap is not demonstrated except at the inferior extent of the mural thickening where there is the suggestion of a short segment flap. There was a tiny focus of mural enhancement on the previous study at this site. Maximum thoracic aortic diameter 3.8 cm.

There is also an 4.6 cm infrarenal fusiform abdominal aortic aneurysm extending to the bifurcation of the aorta with a 2.6 cm neck. Scattered calcific atheroma.


1. The findings are consistent with aortic intramural hematoma (Type B).

Case Discussion

Aortic intramural hematomas (AIHs) are a type of acute aortic syndrome and result from rupture of the vaso vasorum and hemorrhage into the tunica media. Most (95%) AIHs are non-traumatic. The risk factors are the same for aortic dissection. 

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