Presentation
Chest pain radiating to the neck lasting for ten minutes.
Patient Data
Non-contrast images show a subtle crescentic hyperdensity, suggestive of an intramural hematoma, along the wall of the ascending aorta extending to the aortic arch.
Contrast-enhanced images demonstrate an ascending aortic aneurysm (diameter 5.5 cm) with an intramural hematoma of 14 mm thickness, extending from the aortic root to the aortic arch at the origin of the right brachiocephalic trunk. Delayed post-contrast images show enhancing foci, indicative of active bleeding or intramural blood pool, within the intramural hematoma. There is no discrete intimal entry tear.
There is co-existing minimally dense, possibly hemorrhagic, pericardial fluid.
- red arrow = enhancing foci, indicative of active bleeding or intramural blood pool, within the intramural hematoma
- blue arrow = ascending aortic aneurysm
- yellow arrow = intramural hematoma
Case Discussion
Aortic intramural hematoma, which is one of the acute aortic syndromes, is due to bleeding within the aortic wall. It may be caused by rupture of the vasa vasorum within the media or due to hemorrhage from a penetrating atherosclerotic ulcer.
The CT scan shows a type A aortic intramural hematoma. Most intramural hematomas (60-70%) involve the descending aorta (type B) and has better prognosis than those involving the ascending aorta (type A). The lesion may resolve, remain stable or evolve into a full-blown aortic dissection or aneurysm.
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