[Aortic intramural hematoma: aspects with spiral computerized tomography].
OBJECTIVE
To evaluate the signs of aortic intramural hematoma with helical CT and the diagnostic role of this technique in patients with this condition.


METHODS
We reviewed the CT findings of 396 patients submitted to emergency examinations for suspected aortic dissection from 1995 to 1999. Only 18 patients (6 women and 12 men) had CT signs of aortic intramural hematoma. Helical CT studies were carried out with the following parameters: slice thickness 10 mm, reconstruction index 10, feed 1.5 mm, conventional algorithm with minimum values of 130 kV and 125 mA. All patients were examined with dynamic contrast-enhanced CT, before and after a power injection of 130 mL ionic contrast material. We studied: hematoma localization and longitudinal extension; thickness and density of aortic wall; presence and location of intimal calcifications; integrity of intimal wall; hemomediastinum and/or hemothorax.


RESULTS
Aortic wall thickening appeared as a high density crescent-shaped area at baseline CT and had low density on enhanced images in all patients. Thickening was eccentric in 14/18 patients and concentric in 4/18 only; it always exceeded 4 mm. We found some intimal calcifications in 8 patients and hemothorax and/or hemomediastinum in 9 patients. A patient with type A hematoma died of cardiac tamponade a few hours after CT diagnosis. Six patients (5 type B and 1 type A) underwent anti-hypertensive treatment and radiological follow-up. Eleven patients (6 type A and 5 type B) underwent prosthesis replacement and 5 of them (3 type A and 2 type B) died of postoperative complications. In the 5 type B patients surgery was performed because of treatment-resistant pain and of the onset of ischemic complications to abdominal organs caused by involvement of the main collateral branches of the aorta. One patient with type A hematoma was submitted to drug treatment because it was judged unresectable.


CONCLUSIONS
Intramural hematoma of the aorta is a distinct pathological entity, which should not be confused with aortic dissection. The imaging techniques (TEE, CT, MRI) have an important role in the final diagnosis of aortic hematoma. Presently Helical CT and MR angiography are the main tools in the early diagnosis of this condition before the development of complications. In our experience helical CT, before and after the administration of contrast material, was accurate in identifying the hematoma localization and extension.
Midiri
M
M
Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Diagnostica per Immagini, Università degli Studi, Bari.
Strada
A
A
Stabile Ianora
A A
AA
Scialpi
M
M
D'Agostino
D
D
De Luca Tupputi Schinosa
L
L
Angelelli
G
G
Rotondo
A
A
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*