title: Acute aortic dissection with intramural hematoma: possibility of transition to classic dissection or aneurysm.
abstract: Acute aortic dissection with intramural hematoma has been believed to have a good prognosis, but we have encountered the transition of this entity to a classic dissection or aneurysm. We report the serial computed tomography (CT) features in 27 cases of acute aortic dissection with intramural hematoma. Eleven patients (40.7%) developed a classic dissection or aneurysm during follow-up. Four patients (14.8%) showed transition to a classic dissection without resolution of the intramural hematoma; each had a dilated ascending aorta measuring > 5 cm in diameter on the initial CT. One case (3.7%) developed an enlarging aneurysm without resolution of the intramural hematoma. In 19 cases (70.4%), the hematoma resolved; among these 19, the aortic diameter was significantly larger (p < 0.01) than those in a normal control group. Two of these 19 later developed an aneurysm, and four developed a classic dissection. This entity often (40.7%; 11 of 27) required surgical intervention or periodic follow-up CT examinations, particularly with a dilated ascending aorta of > 5 cm in diameter.
authors.affiliation: Department of Radiology, Nara Medical University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ide
authors.forename: H
authors.initials: H
authors.lastname: Uchida
authors.forename: H
authors.initials: H
authors.lastname: Otsuji
authors.forename: K
authors.initials: K
authors.lastname: Nishimine
authors.forename: J
authors.initials: J
authors.lastname: Tsushima
authors.forename: H
authors.initials: H
authors.lastname: Ohishi
authors.forename: S
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed