CTICasesType A Intramural Hematoma with Focal Intimal Tear
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Imaging findings
Non-contrast CT demonstrates a high-attenuation crescent within the wall of the ascending aorta consistent with an intramural hematoma, accompanied by hemopericardium and mediastinal soft-tissue stranding. Contrast-enhanced CT reveals a focal, subtle intimal defect and a linear filling defect measuring approximately 1.5 cm along the medial aspect of the ascending aorta just above the aortic root.
Key takeaways
An intramural hematoma associated with a localized, short-segment intimal tear is sometimes referred to as a limited aortic dissection. Because transthoracic and transesophageal echocardiograms can frequently be false-negatives in the setting of limited intimal defects, high-resolution electrocardiogram-gated CT is crucial to detect the entry tear and guide emergent surgical repair for type A lesions.
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