CTICasesTakayasu Arteritis with Acute Intramural Hemorrhage Mimicking Intramural Hematoma
Imaging findings
CT of the aorta demonstrates extensive circumferential wall thickening that initially appears exactly like an intramural hematoma: thick, soft-tissue attenuation material surrounds the entire aorta from the arch through the descending aorta. Atypical features include involvement extending to the left main coronary, SMA, bilateral renal arteries, and iliac vessels in an infiltrative rather than circumscribed pattern. A follow-up CT the same day shows dramatic reduction in wall thickness, particularly in the descending aorta and around the renal arteries, which would be atypical for intramural hematoma. Surgical pathology of the resected ascending aorta shows findings consistent with vasculitis and specifically Takayasu arteritis, with superimposed acute intramural hemorrhage.
Key takeaways
Takayasu arteritis can present with acute aortic wall thickening from superimposed hemorrhage into an inflamed vessel wall, mimicking intramural hematoma. Features that should raise suspicion for vasculitis rather than true intramural hematoma include: involvement extending below the renal arteries and into branch vessels (renals, SMA, iliac), circumferential involvement that tracks along branch vessel origins, rapid spontaneous reduction in wall thickness on follow-up CT, and patient demographics typical for Takayasu arteritis (younger women). Pathologic confirmation of vasculitis on resected aorta is definitive.
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