Presentation
Acute tearing intrascapular chest pain.
Patient Data
Prominant aortic arch. Tortuous descending aorta.
Hyperdense crescent sign of the aortic arch and descending aorta on non contrast imaging indicating intramural hematoma, which starts distal to the left subclavian artery origin. No dissection on the arterial phase. Minor enhancement of the descending aortic intramural hematoma anteriorly. Ascending aorta and arch vessels are normal.
Bilobed infrarenal AAA with mural thrombus terminates at the bifurcation. No features of complication.
No end organ infarction.
Early enhancement of the IVC and hepatic veins due to contrast reflux from the right atrium into IVC (passive hepatic congestion).
Case Discussion
Features indicate a type B aortic intramural hematoma (IMH) which is part of the acute aortic syndrome.
The patient's BP was 180/120 mmHg.
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