File:Aortic intramural hematoma with dissection and intramural blood pool (Radiopaedia 77373-89491 D 53).jpg

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Aortic_intramural_hematoma_with_dissection_and_intramural_blood_pool_(Radiopaedia_77373-89491_D_53).jpg ‎(548 × 548 pixels, file size: 106 KB, MIME type: image/jpeg)

Summary:

Description
  • Radiopaedia case ID: 77373
  • Image ID: 52603264
  • Image stack position: 53/89
  • Plane projection: Sagittal
  • Aux modality: C+ arterial phase
  • Modality: CT
  • System: Chest
  • Findings: Eccentric increased density on the non-contrast study (best in the arch) represents acute aortic intramural hematoma, commencing at the aortic root, and extends into the descending thoracic aorta at the level of T10. No acute dissection flap is seen. Intramural hematoma extends into bilateral common carotid arteries proximally to the level of C5; vessel patency and opacification above this level appear maintained. Intramural hematoma extends for a short distance (approximately 1 cm) into the proximal left vertebral artery, with preservation of distant vessel patency. A large intramural hematoma causes near-complete occlusion of the left subclavian, axillary and brachial arteries with a thin sliver of enhancing lumen remaining present. Right upper limb arteries are well opacified. Just proximal to the dissection in the proximal descending aorta, a small contrast focus in the right posterolateral aspect of the intramural hematoma is seen in continuity with a right posterior intercostal artery and represents an intramural blood pool (IMBP). Thin pericardial effusion and stranding in the superior epicardial fat. No features of pericardial tamponade. The chronic type B aortic dissection appears similar in extent to the prior studies. This commences just distal to the left subclavian artery origin, and is chronically thrombosed from the level of the mid-thoracic aorta inferiorly. The opacified true lumen extending further distally to the level of L3 is similar in extent to the initial study performed 6 years prior. The celiac trunk, superior and inferior mesenteric arteries are supplied by the true lumen. Hypoattenuation indicating hypoperfusion of the right renal parenchyma. Other findings Dual-lead pacemaker in a left pectoral position. Scattered coronary artery calcification. No significant mediastinal or hilar lymphadenopathy. Bilateral lower lobe subsegmental atelectasis. Mild dependent ground-glass opacity within the upper lobes bilaterally suggest mild pulmonary edema. No pleural effusion or pneumothorax. The liver, gallbladder, spleen, pancreas and right adrenal gland appear normal. 18 mm left adrenal nodule is stable. Small splenunculus. Noninflamed distal colonic diverticulosis. No intraperitoneal free fluid, free air or lymphadenopathy. No acute bony abnormalities. IMPRESSION
Date Published: 4th Jun 2020
Source https://radiopaedia.org/cases/aortic-intramural-haematoma-with-dissection-and-intramural-blood-pool
Author Craig Hacking
Permission
(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

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Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0)

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