CTICasesAcute Type A Aortic Intramural Hematoma
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Imaging findings
Non-gated non-contrast chest CT demonstrates a crescent of high attenuation within the wall of the ascending and descending thoracic aorta. Contrast-enhanced CT confirms a non-enhancing thickened aortic wall, consistent with a Stanford Type A intramural hematoma. Surgical exploration revealed an intimal tear just above the right coronary artery.
Key takeaways
Intramural hematoma is an acute aortic syndrome characterized by hemorrhage within the media of the aortic wall without a patent false lumen or visible intimal tear on imaging. It is best diagnosed on non-contrast chest CT as a high-attenuation crescent. Type A intramural hematomas involve the ascending aorta and are treated as surgical emergencies, similar to classic Type A aortic dissections.
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