Aortic Intramural Hematoma

Abstract

As a component of the acute aortic syndrome (AAS), aortic intramural hematoma (IMH) is a life-threatening pathologic process that differs from aortic dissection in that it is caused by spontaneous hemorrhage within the media of the aortic wall, without associated intimal rupture or dissection flap. On imaging, the diagnostic criteria are the presence of a circular or crescent-shaped thickening of ≥5 mm of the aortic wall without detectable blood flow [Erbel et al. Eur Heart J 35(41):2873–926; 2014]. The extent of IMH can be limited or scattered; besides, the Stanford classification system can also be applied to IMH. The natural progression of IMH is not clear enough yet; its prognosis can be completely absorbed or progressing to aortic rupture, classical dissection, and aneurysm [Von Kodolitsch et al. Circulation 107(8):1158–63; 2003]. Accurate diagnosis is of great importance for the management of these patients. Recently, CT especially electrocardiographic gating CT angiogram is the primary technique for the diagnosis and classification of IMH. In this chapter, the CT imaging manifestations of it will be discussed based on a case of IMH.