CTICasesType A Aortic Intramural Hematoma Misdiagnosed as Aortitis
Imaging findings
Initial CTA demonstrates soft tissue density surrounding the aorta and extending along the main and branch pulmonary arteries, interpreted as pulmonary vasculitis at an outside hospital. PET/CT one week later shows a crescentic hyperdensity in the ascending aorta that is relatively cold. Follow-up CTA weeks later during stroke-like presentation reveals luminal irregularity of the proximal aortic arch and eccentric soft tissue thickening of the ascending aorta consistent with interval progression of a type A dissection.
Key takeaways
Acute aortic intramural hematoma (IMH) with periaortic blood tracking along the bronchovascular sheaths into the pulmonary interstitium can closely mimic aortitis or even pulmonary vasculitis on CT. The distinguishing feature is the hyperattenuating crescent on non-contrast CT. The life-threatening nature of type A IMH means misdiagnosis and outpatient management can be fatal, as this is a surgical emergency.
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