CTICasesRuptured Type B Aortic Intramural Hematoma with Hemothorax
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Imaging findings
Contrast-enhanced chest CT shows a large, hyperdense crescentic thickening of the descending thoracic aortic wall, consistent with an acute intramural hematoma. There is a focal disruption of the intima with a plume of extravasating contrast indicating a localized rupture, associated with a large, high-attenuation right-sided hemothorax.
Key takeaways
Acute aortic syndromes, including intramural hematoma (IMH), carry a high risk of catastrophic rupture. While pleural effusions in aortic dissection or IMH are often reactive/serous and left-sided due to impaired lymphatic drainage, a high-attenuation effusion (especially on the right) must raise immediate concern for direct rupture and hemothorax, requiring emergent surgical or endovascular intervention.
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