EURORAD ESR

Case 15455

Mediastinal haematoma dissecting the sheath of the pulmonary arteries: A rare manifestation of acute aortic syndrome

Author(s)
González Moreno IM, Plasencia Martínez JM, Blanco Barrio A, Moreno Pastor A.

Radiology Department,
Hospital General Universitario José Mª Morales Meseguer,
Murcia, Spain
Email:im.gonzalezmoreno@gmail.com
 
Patient
female, 85 year(s)
 
 
  • Figure 1
    Images in the axial plane; arterial and delayed phases.
     

    The CTPA revealed a dense non-enhancing mass on the infero-posterior wall of the right main pulmonary artery, consistent with blood (*), which reduced the pulmonary artery (PA) lumen to a filiform strand of contrast.

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;

    Delayed phase showed a dilated ascending aorta with a subtle irregular contour in the posterior wall (black arrow) in close contact with the haematoma (*). Bilateral thickening of the peribroncovascular interstitium...

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;

    Contrast reflux to suprahepatic veins (white arrow).

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;

    Dilated right heart chambers (arrow) and haemopericardium (arrowhead).

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;
     
     
  • Figure 2
    CTPA delayed phase images in axial and sagittal planes.
     

    On axial and sagittal CT reconstructions, an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery. Bilateral thickening of the peribronchovascular...

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;

    On sagittal CT reconstructions, (venous phase) an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery (PA) that is compressed.

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;

    On sagittal CT reconstructions (arterial phase), an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery (PA) that is compressed.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Acute;
     
     
  • Figure 3
    Representative axial videos
     

    CTPA in axial plane. We add a video showing the described findings.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Acute;

    CT in axial plane (venous phase). We add a video showing the described findings.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT; Procedure: Computer Applications-General; Special Focus: Acute;
     
     
  • Figure 4
    Schematic drawing

    Schematic drawing based on the literature. Craniocaudal view of the ascending aorta and pulmonary artery. Pulmonary arteries are severely compressed by the haematoma (*). The tear point is on the posterolateral wall...

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Imaging Technique: CT; Procedure: eLearning; Special Focus: Acute;
     
     
The CTPA revealed a dense non-enhancing mass on the infero-posterior wall of the right main pulmonary artery, consistent with blood (*), which reduced the pulmonary artery (PA) lumen to a filiform strand of contrast.
 
Delayed phase showed a dilated ascending aorta with a subtle irregular contour in the posterior wall (black arrow) in close contact with the haematoma (*). Bilateral thickening of the peribroncovascular interstitium (white arrowhead).
 
Contrast reflux to suprahepatic veins (white arrow).
 
Dilated right heart chambers (arrow) and haemopericardium (arrowhead).
 
On axial and sagittal CT reconstructions, an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery. Bilateral thickening of the peribronchovascular interstitium (white arrowhead).
 
On sagittal CT reconstructions, (venous phase) an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery (PA) that is compressed.
 
On sagittal CT reconstructions (arterial phase), an intimal flap (black arrow) was visible in the posterior wall of the ascending aorta adjacent to the right pulmonary artery (PA) that is compressed.
 
CTPA in axial plane. We add a video showing the described findings.
 
CT in axial plane (venous phase). We add a video showing the described findings.
 
Schematic drawing based on the literature. Craniocaudal view of the ascending aorta and pulmonary artery. Pulmonary arteries are severely compressed by the haematoma (*). The tear point is on the posterolateral wall (arrow) of the aorta.
 
 
 
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