CTICasesType A Intramural Hematoma with Hemopericardium and Pulmonary Artery Wall Blood Tracking
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Imaging findings
Non-contrast CT demonstrates high-attenuation crescentic thickening of the ascending aortic wall and hemopericardium, while contrast-enhanced CT shows a very subtle intimal dissection tear. Notable blood tracking is also visible within the wall of the main pulmonary artery, reflecting extension within the shared adventitial sheath of the great vessels.
Key takeaways
Acute aortic syndromes such as type A intramural hematomas can be misdiagnosed as mediastinitis on CT if the high attenuation of the hematoma on non-contrast scans is overlooked. Blood tracking along the main pulmonary artery wall is a known finding due to the shared pericardial and adventitial sheath with the ascending aorta.
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