title: Hemorrhagic infiltration of the aortopulmonary adventitia: A complication of acute aortic dissection.
abstract: BACKGROUND
  Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute aortic dissection, most frequently Stanford type A. The radiological interpretation of this finding may be a diagnostic challenge. The objective of this multicenter case series is to review the radiological and pathological findings of hemorrhagic infiltration of the aortopulmonary adventitia secondary to acute aortic dissection, and to describe the pathophysiology underlying this complication.
  
  
  METHODS
  The study includes 20 cases of aortic dissection with hemorrhagic infiltration of the aortopulmonary adventitia. These are 17 cases with computed tomography (CT) data obtained from 5 academic centers. Three other cases were retrieved through a search of autopsy reports. Clinical, radiological and pathological data were collected.
  
  
  RESULTS
  Linear foci of moderately increased attenuation were seen along the wall of the proximal pulmonary arteries in 4 cases on unenhanced CT. Contrast-enhanced CT showed soft-tissue thickening along these walls in all imaging cases, with some degree of narrowing of the lumen of the pulmonary arteries. Peribronchovascular ground-glass opacities or consolidation were present in 4 cases.
  
  
  CONCLUSIONS
  Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute type A aortic dissection. The radiologist should be aware of its pathophysiology and imaging findings in order to make a prompt diagnosis in an urgent setting.
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, Québec H2X 3J4, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Guilmette
authors.affiliation: Department of Radiology, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Québec H3A 2B4, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Semionov
authors.affiliation: Department of Diagnostic Imaging, The Ottawa Hospital General Campus, Room S2, Box 232, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Dennie
authors.affiliation: Department of Radiology, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Gahide
authors.affiliation: Department of Radiology, Hôpital du Sacré-Cœur de Montréal, 5400 ouest, boul. Gouin, Montréal, Québec H4J 1C5, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Pressacco
authors.affiliation: Department of Pathology, Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Fraser
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu du CHUM, 3840 rue Saint-Urbain, Montréal, Québec H2W 1T8, Canada.
authors.forename: M-P
authors.initials: MP
authors.lastname: Cordeau
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu du CHUM, 3840 rue Saint-Urbain, Montréal, Québec H2W 1T8, Canada. Electronic address: chartrandlef@videotron.ca.
authors.forename: C
authors.initials: C
authors.lastname: Chartrand-Lefebvre
mesh_terms: D000208:Acute Disease; D063194:Adventitia / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications*; D001014:Aortic Aneurysm / Q000150:complications*; D003287:Contrast Media; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Aorta; Aortic dissection; Aortic rupture; Aortopulmonary adventitia; Computed tomography; Mediastinal hemorrhage