CASE 565 Published on 12.01.2002

Blunt traumatic intramural aortic hematoma

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

47 years, male

Categories
No Area of Interest ; Imaging Technique CT, Ultrasound
Clinical History
High-speed truck accident
Imaging Findings
47-year-old male truck driver involved in a high-speed traffic accident. After the admission plain film, the patient underwent chest CT. Since the latter demonstrated an abnormal shape of the aortic contour, a thoracic aortogram was obtained, which confirmed the presence of an aortic intramural hematoma. During surgery, the patient underwent transesophageal echography.
Discussion
In most blunt aortic lesions, only the intima and media are injured. The adventitia is the strongest layer and remains intact. Bleeding from the aorta or from intramural vasa vasora results in a pseudo-aneurysm, featuring an saccular pulsatile outpouching of the aortic lumen limited by a thin layer of adventitia and by neighbouring tissues and usually outlined by a hemomediastinum. In less than 5% of cases, traumatic aortic injuries may relate only to intimal tear, with aortic dissection and/or intramural hematoma. Ninety percent of blunt traumatic aortic lesions lie on the antero-medial aspect of the aortic isthmus. Aortography can demonstrate blunt traumatic lesions within the aortic walls as a sightly abnormal contour. However, it shows little sensitivity in the detection of such lesions, unless coupled with intravascular ultrasound imaging. On the other hand, they are easily depicted by transesophageal echography and spiral CT, as well as, in the future, MR. CT, which is performed in hemodynamically stable patients, features intimal flaps as low-attenuation curvilinear filling defects within the aortic lumen and intramural hematomas as aortic contour deformities or focal biconvex wall thickenings. On TEE images, obtained in the operating room in hemodynamically unstable patients, intramural hematomas are responsible for a double contour of the aortic wall.
Differential Diagnosis List
Blunt traumatic aortic intramural hematoma
Final Diagnosis
Blunt traumatic aortic intramural hematoma
Case information
URL: https://www.eurorad.org/case/565
DOI: 10.1594/EURORAD/CASE.565
ISSN: 1563-4086