title: [Intramural hematoma of the thoracic aorta: diagnostic imaging and differential diagnosis].
abstract: OBJECTIVE
  Aortic wall thickening due to intramural hemorrhage may be the only sign of aortic dissection. The aim of this study was to evaluate the incidence, imaging features and differential diagnoses of intramural hemorrhage (IMH) of the thoracic aorta.
  
  
  METHODS
  98 patients with clinically suspected aortic dissection were investigated via Spiral-CT and MRT. Diagnosis of IMH based on the presence of smooth crescentic or concentric wall thickening over a longer segment of the thoracic aorta without flow visualization and without compression or distortion of the aortic lumen.
  
  
  RESULTS
  69 patients had classic aortic dissections and 7 patients were diagnosed to have IMH of thoracic aorta. One patient with IMH of the ascending aorta died of aortic rupture and subsequent pericardial tamponade 12 hours after onset of symptoms. In one patient with IMH of the descending aorta on initial examination, there was a progression of overt aortic dissection at follow-up after three weeks. In two patients with IMH of the descending aorta, wall thickening decreased in size at follow-up (10-15 weeks), whereas in one patient it remained unchanged.
  
  
  CONCLUSIONS
  IMH of the aorta should be considered a precursor of aortic dissection. At follow-up IMH may decrease in size, rupture or progress to overt aortic dissection.
authors.affiliation: Radiologische Universitätsklinik Bonn.
authors.forename: T
authors.initials: T
authors.lastname: Sommer
authors.forename: D
authors.initials: D
authors.lastname: Abu-Ramadan
authors.forename: M
authors.initials: M
authors.lastname: Busch
authors.forename: E
authors.initials: E
authors.lastname: Bierhoff
authors.forename: B
authors.initials: B
authors.lastname: Kreft
authors.forename: C
authors.initials: C
authors.lastname: Kuhl
authors.forename: G
authors.initials: G
authors.lastname: Lutterbey
authors.forename: E
authors.initials: E
authors.lastname: Keller
authors.forename: H
authors.initials: H
authors.lastname: Schild
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis*; D001018:Aortic Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006406:Hematoma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods