CTICasesRuptured Aortic Intramural Hematoma with Extrapleural Hematoma and Hemothorax
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Imaging findings
Chest radiography demonstrates a discrete opacity on the right side, along with fluid tracking in the pleural space and a layering right-sided effusion. Non-contrast CT reveals an aortic intramural hematoma that has ruptured, with associated displaced extrapleural fat sign and hemothorax. A large, convex extrapleural hematoma is seen adjacent to the layering hemothorax with a clear blood-fluid level.
Key takeaways
Rupture of an aortic intramural hematoma can rarely present with an extrapleural hematoma and concomitant hemothorax, mimicking the findings typically associated with rib fractures and intercostal artery bleeding. Radiographic identification of a displaced extrapleural fat sign can help distinguish extrapleural blood from simple pleural fluid.
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