EURORAD ESR

Case 112

Intramural hematoma of the thoracic aorta

Author(s)
E.Bassetti, A. Petrone, F. Manganaro, C.Catalano
 
Patient
male, 42 year(s)

Clinical History

A 42 year-old male patient with hypertension and thoracic symptoms underwent, in our hospital, transesophageal echocardiography, spiral CT and MRA. The images showed a disomogeneity of the periaortic fluid, suggestive of a recent small bleeding in the context of the aortic wall.

Imaging Findings

Hypertension (220/140) was first noticed at the age of 38. Seven months ago he presented severe dispnea, feeling of heaviness in the chest and palpitation. A transesophageal echocardiography showed hiperecogeneicity of the aortic wall but there was no evidence of pericardial fluid and thoracic aortic dissection. For these reasons he underwent an MRA. The images showed a semilunar periaortic fluid area in the context of the aortic wall (hipointense in T1 W, hyperinten se in T2 W). This area was localized at the level of the descending thoracic aorta, below the origin of the left subclavian artery. To study the clinical evolution of the patient a spiral CT was also performed. The images showed a disomogeneity of the periaortic fluid. It appeared as a recently small bleeding in the contest of the aortic wall.

Discussion

In presence of an intramural aortic hematoma, spiral CT and MRA are the only techniques that allow to perform a correct diagnosis. Furthermore, these non invasive techniques provide an early diagnosis in a short time allowing, the patient to be treated immediately The accuracy of these techniques allow to choose the most useful clinical, surgical or interventional approach for the patient.

Final Diagnosis

Intramural hematoma of the thoracic aorta
 

MeSH

  1. Aorta, Thoracic [A07.231.114.056.372]
    The portion of the descending aorta proceeding from the arch of the aorta and extending to the diaphragm.

References

  1. [1]
    Narimatsu M., et al. Fate of intramural haematoma of the aorta: CT evaluation J-Comput-Assist-Tomogr. 1997 Nov-Dec 21(6): 931-8.

  2. [2]
    Oliver TB, et al. Serial MRI in the management of intramural haemorrhage of the thoracic aorta Br-J-Radiol. 1997 Dec; 70 (840) 1288-90.

  3. [3]
    Schnyder P., et al. "Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury"; Eur-Radiol. 1998; 8 (5). 828-33.

Citation

E.Bassetti, A. Petrone, F. Manganaro, C.Catalano (2000, Jul 31).
Intramural hematoma of the thoracic aorta, {Online}.
URL: http://www.eurorad.org/case.php?id=112
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  • Figure 1
    Spiral CT-image post contrast medium

    It shows the precence of a semilunar periaortic fluid area at the descending segment of thoracic aorta.

     
  • Figure 2
    Spiral CT-image post contrast medium

    It shows the presence of moderately disomogeneous semilunar periaortic fluid area, suggestive of a recent small bleeding in the context of the aortic wall

     
  • Figure 3
    MR-images axial T1 W (a) and axial T2 W (b)
    a b  

    It’s well shown the semilunar periaortic fluid

    It’s well shown the semilunar periaortic fluid

     
  • Figure 4
    MIP-reconstruction

    There is no evidence of epiaortic vessels interest

     
  • Figure 5
    MR T2W image

    The image confirm the presence of intramural hematoma

     
Figure 1

Spiral CT-image post contrast medium

It shows the precence of a semilunar periaortic fluid area at the descending segment of thoracic aorta.
 
Figure 2

Spiral CT-image post contrast medium

It shows the presence of moderately disomogeneous semilunar periaortic fluid area, suggestive of a recent small bleeding in the context of the aortic wall
 
Figure 3

MR-images axial T1 W (a) and axial T2 W (b)

Figure 3a
It’s well shown the semilunar periaortic fluid
 
Figure 3b
It’s well shown the semilunar periaortic fluid
 
Figure 4

MIP-reconstruction

There is no evidence of epiaortic vessels interest
 
Figure 5

MR T2W image

The image confirm the presence of intramural hematoma
 
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