CTICasesAcute Aortic Intramural Hematoma with Pulmonary Artery Involvement
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Imaging findings
Chest radiograph shows a mildly elongated aorta. Non-contrast CT reveals hyperattenuating intramural hematoma within the thickened wall of the ascending aorta, extending to involve a portion of the pulmonary artery. The contrast-enhanced CT confirms a thickened aortic wall, with subtle out-pouching of contrast from the aortic lumen into the wall, indicating a small communication. These findings were surgically confirmed.
Key takeaways
Acute intramural hematoma (IMH) is a form of acute aortic syndrome. This case demonstrates IMH involving both the ascending aorta and the pulmonary artery, a rare extension. The presence of a small communication between the aortic lumen and the hematoma suggests early progression toward dissection or rupture, emphasizing the importance of both non-contrast and contrast imaging for diagnosis and characterization.
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