Images show intramural hematoma of the arch and descending aorta. The small amount of pericardial fluid in the fold adjacent to the ascending aorta complicates assessment for ascending aortic involvement

Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography

Japanese Journal of Radiology ◽

10.1007/s11604-020-01008-1 ◽

2020 ◽

Vol 38 (11) ◽

pp. 1036-1045

Author(s):

Satoru Yanagaki ◽

Takuya Ueda ◽

Atsuro Masuda ◽

Hideki Ota ◽

Yuta Onaka ◽

...

Keyword(s):

Retrospective Study ◽

Aortic Dissection ◽

Ct Angiography ◽

Intramural Hematoma ◽

Ascending Aorta ◽

Single Center ◽

Descending Aorta ◽

Diastolic Phase ◽

Electrocardiogram Ecg ◽

Intimal Tear

Abstract Purpose To compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH). Materials and methods A total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta. Results The accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008). Conclusion Full-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.

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Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211061268 ◽

2021 ◽

pp. 152660282110612

Author(s):

Yingliang Wang ◽

Songlin Song ◽

Chen Zhou ◽

Wenying Zhu ◽

Jiacheng Liu ◽

...

Keyword(s):

Adverse Events ◽

Intramural Hematoma ◽

Type A ◽

Ascending Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Descending Aorta ◽

Aortic Repair ◽

Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

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Acute retrograde type A intramural hematoma treated with an endovascular approach

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318766791 ◽

2018 ◽

Vol 26 (4) ◽

pp. 308-310 ◽

Cited By ~ 3

Author(s):

Anh T Vo ◽

Khoi M Le ◽

Trang T Nguyen ◽

Thanh T Vu ◽

Thien T Vu ◽

...

Keyword(s):

Computed Tomography ◽

Intramural Hematoma ◽

Type A ◽

Sudden Onset ◽

Ascending Aorta ◽

Acute Type ◽

Descending Aorta ◽

Severe Chest Pain ◽

Endovascular Approach

A 71-year-old woman was admitted with sudden onset of severe chest pain. Computed tomography demonstrated acute type A intramural hematoma with an entry tear in the first part of the descending aorta. The patient refused an operation. Endovascular repair was performed to prevent conversion to a typical dissection of the ascending aorta. At the 1-year follow-up, computed tomography showed total resolution of the intramural hematoma.

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Temporoparietal Headache as the Initial Presenting Symptom of a Massive Aortic Dissection

Case Reports in Emergency Medicine ◽

10.1155/2015/626825 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Manan Parikh ◽

Abhinav Agrawal ◽

Braghadheeswar Thyagarajan ◽

Sayee Sundar Alagusundaramoorthy ◽

James Martin

Keyword(s):

Aortic Dissection ◽

Intramural Hematoma ◽

Acute Onset ◽

Ascending Aorta ◽

Medical Emergency ◽

Descending Aorta ◽

Severe Chest Pain ◽

Hemodynamic Compromise ◽

Life Threatening ◽

Prompt Diagnosis

Aortic dissection is a life-threatening medical emergency often presenting with severe chest pain and acute hemodynamic compromise. The presentation of aortic dissection can sometimes be different thus leading to a challenge in prompt diagnosis and treatment as demonstrated by the following presentation and discussion. We present a case of a 71-year-old male who presented to the emergency department with complaints of left sided temporoparietal headache and was eventually diagnosed with a thoracic aortic dissection involving the ascending aorta and descending aorta, with an intramural hematoma in the descending aorta. This case illustrates the importance of keeping in mind aortic dissection as a differential diagnosis in patients with acute onset headaches in which any intracranial source of headache is not found.

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Type A Intramural Hematoma Often Turns Out To Be a Type A Dissection

The Heart Surgery Forum ◽

10.1532/hsf98.2013245 ◽

2013 ◽

Vol 16 (6) ◽

pp. 351 ◽

Cited By ~ 2

Author(s):

Sebastian Michel ◽

Christian Hagl ◽

Gerd Juchem ◽

Ralf Sodian

Keyword(s):

Computed Tomography ◽

Surgical Repair ◽

False Lumen ◽

Intramural Hematoma ◽

Acute Chest Pain ◽

Type A ◽

Ascending Aorta ◽

Descending Aorta ◽

Type A Dissection ◽

Thrombosed Type

Background: The management of type A intramural hematoma (IMH) is controversial. Although most Western countries still recommend immediate surgical repair, some centers in Asia have shown good results recently with medical treatment alone. Here, we present a case of type A IMH which was discovered during the operation to be a thrombosed type A dissection.Case Report: An 83-year-old female patient presented with acute chest pain. After diagnostic exclusion of myocardial infarction, computed tomography was performed, which showed an IMH from the ascending to the descending aorta. No intimal flap could be detected. The ascending aorta was replaced surgically with a prosthesis. During the operation, we found a ruptured intimal plaque, which had caused dissection of the aorta with thrombosis of the false lumen. The true diagnosis�thrombosed type A dissection and not IMH�was revealed neither by computed tomography nor by transesophageal echocardiography.Conclusion: Type A IMH should still be treated with immediate surgical repair because in many cases it turns out to be thrombosed type A dissection.

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Images at the time of admission show increased size of the stented descending aorta with type II endoleak. Also seen is a thin rim of intramural hematoma of the ascending aorta

ASVIDE ◽

10.21037/asvide.2018.340 ◽

2018 ◽

Vol 5 ◽

pp. 340-340

Author(s):

Paul Schoenhagen

Keyword(s):

Intramural Hematoma ◽

Ascending Aorta ◽

Type Ii ◽

Type Ii Endoleak ◽

Descending Aorta ◽

Time Of Admission

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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