Joaquin Ferreiros PhD, Presenter: Nothing to Disclose

Monica Santamarķa MD, Abstract Co-Author: Nothing to Disclose

Angela Garcia MD, Abstract Co-Author: Nothing to Disclose

Ana Bustos, Abstract Co-Author: Nothing to Disclose

Isidre Vilacosta MD, Abstract Co-Author: Nothing to Disclose

To assess the evolution on follow-up imaging studies of patients with acute aortic syndrome due to type B aortic intramural hematoma (IMH) presenting initially with localised areas of contrast enhancement within the IMH, as shown on CT and/or MRA imaging.

From 1995 to 2004, twelve patients with acute aortic syndrome were diagnosed as type B intramural aortic hematoma (IMH), based on imaging findings on contrast-enhanced CT (two patients), or contrast-enhanced CT and MRA (ten patients). CT studies often included a pre-contrast CT examination. MRA studies included ECG-gated T1 weighted SE and gadolinium-enhanced 2D or 3D MRA sequences. Ulcer-like projections of contrast enhancement within the IMH or areas of localised dissection were carefully assessed on the source images, multiplanar reformations were used as needed. Follow-up of patients was performed with contrast-enhanced CT and/or MRA.

Six patients had focal areas of contrast enhancement within the IMH: five patients had single (two cases) or multiple (three cases) ulcer-like projections, and one patient had a very short dissection of the abdominal aorta and proximal celiac trunk. Total regression of both the IMH and contrast enhancement areas occurred in four patients (two developed a mild aortic aneurysm and one a mild celiac trunk aneurysm). In one patient, the IMH regressed but a lesion resembling a small penetrating atherosclerotic ulcer remained two months later. In one patient, an ulcer-like projection located just distal to the left subclavian artery, evolved into a localised pseudoaneurysm, requiring a stent-graft placement years later.Six patients had no ulcer-like projections nor localised areas of dissection within the IMH: four IMH regressed completely (one patient developed a mild aortic aneurysm), one IMH slightly diminished over time, and one patient was lost on follow-up.

Half our patients with otherwise typical acute type B aortic IMH presented initially with localised areas of contrast enhancement within the IMH, indicating a focal intimal disruption, with complete regression over time in most cases and only one progression into a pseudoaneurysm.

Ferreiros, J, Santamarķa, M, Garcia, A, Bustos, A, Vilacosta, I, Follow-up of Patients with Acute Aortic Intramural Hematoma (IMH) Presenting Initially with Ulcer-like Projections or Localized Areas of Dissection on Contrast-enhanced CT and/or MRA Imaging.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4415468.html