CTICasesRecurrent Type A Intramural Hematoma with Ulcer-Like Projection
Imaging findings
Serial CT chest scans in a patient with medically managed Type A intramural hematoma (IMH) show initial resolution at one month. A follow-up CT one week later shows recurrence of the IMH, now complicated by a rapidly enlarging ulcer-like projection (ULP) in the ascending aorta.
Key takeaways
Type A aortic intramural hematoma is a dynamic disease that can resolve but then recur or progress rapidly. The development of a new ulcer-like projection (intimal breach) indicates a high risk of rupture or progression to frank aortic dissection, necessitating urgent surgical intervention.
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