Helical CT: a useful technique in the evaluation of aortic intramural hematoma

Abstract

Purpose: To investigate the diagnostic role of helical CT in aortic intramural hematoma. Material and methods: We retrospectively evaluated CT images obtained during a 6-year period, between 1994 and 2000, in 427 patients who underwent helical CT. Only 21 patients had typical findings of aortic intramural hematoma. All studies were performed with helical technique before and after a power injection of nonionic contrast material. Results: Twenty-one patients had aortic wall thickening (9 type A and 12 type B in Stanford's classification). Wall thickening was more than 4 mm in all cases, it was irregular in shape in 16/21 patients (76 %) and had a regular concentric shape in the remaining 5/21 patients (24 %). One patient with type A hematoma died soon after CT diagnosis because of arrhythmia caused by hemopericardium. Five patients (4 type B and one type A) underwent pharmacological therapy and radiological follow-up. Fifteen patients (7 type A and 8 type B) underwent prosthetic surgery and six of these died of postoperative complications. Conclusion: Helical CT represents the first step in the early diagnosis of aortic intramural hematoma before complications develop. In our experience, which agrees with the reports of other authors, helical CT is an accurate and valuable investigation for identifying the location and extent of an aortic intramural hematoma.