CTICasesAcute Aortic Syndrome (PAU/IMH) with Mediastinal Hematoma and Hemothorax
Imaging findings
Serial chest CTs demonstrate hyperattenuating left pleural fluid consistent with a massive hemothorax, significant para-aortic mediastinal hematoma, and progressive focal dilation and thinning of the descending thoracic aortic wall. An ulcer-like projection representing a penetrating atherosclerotic ulcer with surrounding intramural hematoma is observed, with progressive changes and wall degradation over several days.
Key takeaways
Penetrating atherosclerotic ulcer and associated intramural hematoma are components of acute aortic syndrome. In the absence of a frank ruptured aneurysm, severe mediastinal hemorrhage and hemothorax can result from blood tracking and oozing through compromised adventitial tissues, which indicates highly unstable pathology necessitating urgent endovascular or surgical repair.
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