CTICasesIntramural Hematoma of the Ascending Aorta with Evolution to an Ulcer-Like Projection
Imaging findings
Serial chest radiography shows interval widening of the right-convex mediastinal interface. Contrast-enhanced CT angiogram reveals a large, wide-necked, ulcer-like projection extending from the ascending aorta, accompanied by non-opacified thrombus or hematoma. Retrospective evaluation of a prior low-dose non-contrast CT from a SPECT V/Q scan demonstrates a hyperattenuating intramural hematoma (IMH) of the ascending aorta in the exact region where the ulcer-like projection subsequently developed.
Key takeaways
Intramural hematoma (IMH) of the aorta is a dynamic acute aortic syndrome that can evolve over time into an ulcer-like projection (ULP) or a frank pseudoaneurysm. Unlike traditional penetrating atherosclerotic ulcers (PAUs), which occur in the setting of severe atherosclerosis and are typically confined to the descending or abdominal aorta, ULPs can develop in the ascending aorta following an acute IMH without underlying atherosclerotic plaque.
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