CTICasesAortic Intramural Hematoma
Imaging findings
CTA of the chest and neck in a patient presenting with a stroke shows a history of previous dissection repair (aortic arch stent graft and Carrel patch). A new, extensive acute aortic intramural hematoma (IMH) is present, seen as an eccentric, hyperdense wall thickening of the ascending aorta and arch. The hematoma extends into the innominate artery and left common carotid artery, causing severe lumen narrowing. A focal intimal breach (leak) is noted just proximal to the aortic stent graft.
Key takeaways
Aortic intramural hematoma (IMH) is a variant of aortic dissection characterized by hemorrhage within the media of the aortic wall without a patent false lumen. It can track along the branch vessels (such as the innominate and carotid arteries), causing extrinsic compression and narrowing of the true lumen, which can result in acute thromboembolic stroke. Identification of an intimal breach indicates communication with the lumen and guides surgical or medical management.
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