Case of the Week: May 29-June 5, 2020

80 yo female presents to the ER with 2 day history of back pain. Two static images, without and with contrast enhancement, from CTA Chest are presented.

What is your diagnosis?

(Click for a larger image.)





Case Details

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The first non-contrast enhanced image demonstrates an IMH or intramural hematoma. The second, contrast-enhanced, image demonstrates IMBP or intramural blood pool(s), also known as intramural branch artery psuedoaneurysm(s).

Answer

Diagnosis: Intramural Hematoma

Both IMH and IMBP, along with PAU or penetrating atherosclerotic ulcer, and aortic dissection are included in the category of acute aortic syndrome.

This patient went on to endovascular stent grafting of the thoracic aorta with coverage and occlusion of the left subclavian artery, with left common carotid to subclavian bypass.

 

Reference: 

Radiographics. Emerging Concepts in IMH Imaging. May 10 2016 https://doi.org/10.1148/rg.2016150094

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    VCU Department of Thoracic Imaging Virginia Commonwealth University VCU Medical Center