CTICasesIatrogenic Aortic Dissection with Intramural Contrast
Imaging findings
A scout CT shows a triangular-shaped area of increased attenuation along the aorta. On CT, extremely dense, uniform intravenous contrast is seen in the wall of the descending thoracic aorta, suggesting an iatrogenic intramural hematoma or dissection. In the infrarenal aorta, a frank dissection flap communicates with a diseased aorta, likely an abdominal aortic aneurysm, associated with tortuous vessels. A follow-up two days later shows almost complete resolution of the contrast and dissection.
Key takeaways
Iatrogenic aortic dissection or intramural hematoma can result from attempted catheterization, especially with tortuous vessels. Contrast extravasating into the aortic wall may resolve spontaneously. Radiographs can show subtle signs, such as lumen loosening, but these can be challenging to interpret prospectively.
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