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 haematoma, 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 haematoma 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 haematoma. There is no discrete intimal entry tear.
There is co-existing minimally dense, possibly haemorrhagic, pericardial fluid.
- red arrow = enhancing foci, indicative of active bleeding or intramural blood pool, within the intramural haematoma
- blue arrow = ascending aortic aneurysm
- yellow arrow = intramural haematoma
Case Discussion
Aortic intramural haematoma, 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 haemorrhage from a penetrating atherosclerotic ulcer.
The CT scan shows a type A aortic intramural haematoma. Most intramural haematomas (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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