Presentation
Acute abdominal pain radiating to the back. ECG in the ambulance was normal, so was air saturation, but blood pressure was falling and no pulse palpated. The patient was taken directly to the radiology department and was then admitted to the ICU.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Intramural hematoma can be distinguished from a mural thrombus by identification of the intima: a mural thrombus lies between the intima (which is frequently calcified) and the lumen, whereas an intramural hematoma is subintimal.
Case Discussion
The density in the aortic wall is of blood, not atherosclerosis as it was mistaken to be. The "mass" in the posterior mediastinum has the density of blood and proved to be blood, as was the right pleural effusion. Intramural hematoma weakened the aorta and progressed to rupture of the aortic wall and bleeding into the mediastinum. It may have been caused by a penetrating atherosclerotic ulcer.
The patient died within two hours after CT.
Summary: acute deterioration plus intramural hemorrhage suggest that changes in the mediastinum and the pleura are most likely to be blood.
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