CTICasesAcute Aortic Intramural Hematoma with Intimal-Medial Breach
Imaging findings
Frontal chest radiography demonstrates apparent widening of the aortic arch with displacement of intimal calcification away from the outer aortic soft-tissue border. Non-contrast and contrast-enhanced CT confirm a hyperattenuating crescentic intramural hematoma (IMH) involving the aortic arch and descending aorta. On the CT angiogram, a focal intimal-medial breach is identified as a localized channel of contrast material extending from the aortic lumen directly into the hematoma.
Key takeaways
Displacement of intimal calcification from the outer aortic wall on chest radiography is a classic indicator of an acute aortic syndrome, such as an intramural hematoma (IMH) or aortic dissection, though clinicians must be aware of potential false positives caused by beam angulation. CT angiograms of patients with IMH should be scrutinized for a localized intimal-medial breach, which represents a micro-tear and can serve as a precursor to progressive aortic dissection or rupture.
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