CTICasesIatrogenic Aortic Intramural Hematoma from Coronary Angioplasty
Imaging findings
CT in a patient referred with chest pain and concern for aortic dissection shows fluid more circumferential than the usual pericardial recess distribution, with fluid around the right main pulmonary artery and pericardium; non-contrast imaging shows this material to be markedly hyperdense, measuring around 130 Hounsfield units. There is contrast or blood extending along the shared adventitial sheath between the pulmonary arteries and into the pericardial recesses, including the left pulmonary venous recess and the transverse and oblique sinuses, as well as into the mediastinum, without a discrete dissection flap.
Key takeaways
The patient had undergone cardiac catheterization the day before with balloon angioplasty of the right coronary artery ostium for a coronary dissection; persistent contrast pooling in the aortic wall on the angiogram indicated an iatrogenic intramural injury of the aorta from the procedure rather than a spontaneous dissection. The hyperattenuating material on CT most likely represents a mixture of extravasated blood and residual iodinated contrast within the aortic wall and pericardial recesses, illustrating how catheter-related instrumentation can produce an intramural aortic injury that mimics spontaneous dissection.
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