Intramural hematoma of the thoracic aorta: MR image findings and their prognostic implications.
OBJECTIVE
To evaluate magnetic resonance (MR) imaging findings of intramural hematoma of the thoracic aorta and their relationship to prognosis.


METHODS
MR images of 22 patients with intramural hematoma of the thoracic aorta were reviewed retrospectively. Site, thickness, degree of mural involvement, and signal intensity on spin-echo (SE) and cine gradient-echo (GRE) images of the hematoma were noted. MR findings of patients who did and those who did not develop complications were compared.


RESULTS
Hematoma site was the only MR finding that correlated significantly with patient outcome. Complication frequencies in four (80%) of five patients with hematoma of the ascending aorta (type A) and in two (12%) of 17 patients with hematoma of the descending aorta (type B) were significantly different (P = .009). There were moderately strong correlations between days after symptom onset and signal intensity of the hematoma on SE (r = 0.78) and GRE (r = 0.72) images. MR images of two of three patients who developed early-subacute complications showed signal intensity changes of the hematoma that were consistent with recurrent bleeding.


CONCLUSIONS
Patients with MR findings consistent with type A intramural hematoma of the thoracic aorta should undergo surgery. In cases of type B intramural hematoma of the thoracic aorta, MR imaging can be useful for detecting complete resolution or impending complications of the hematoma.
Murray
J G
JG
Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA.
Manisali
M
M
Flamm
S D
SD
VanDyke
C W
CW
Lieber
M L
ML
Lytle
B W
BW
White
R D
RD
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis*; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis*; D001019:Aortic Rupture / Q000175:diagnosis*; D005260:Female; D006406:Hematoma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011379:Prognosis; D013997:Time Factors; D014651:Vasa Vasorum / Q000473:pathology