CTICasesDynamic Acute Aortic Dissection / Intramural Hematoma
Imaging findings
Initial CT chest shows a massive, low-attenuation wall thickening of the thoracic and abdominal aorta (extending into the coronaries, renal arteries, and causing iliac compression), mimicking a huge, non-hyperdense IMH. A repeat scan 12 hours later shows dramatic decrease in the wall thickening and a corresponding increase in attenuation of the remaining hematoma.
Key takeaways
Acute aortic syndrome can be a highly dynamic process. Rapidly changing wall thickening and fluctuating hematoma sizes suggest a dynamic aortic dissection with moving, unclotted blood in the wall rather than a static, clotted intramural hematoma. As the blood pools and clots, the attenuation values typically increase.
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