Eijun Sueyoshi MD, Presenter: Nothing to Disclose

Ichiro Sakamoto MD, Abstract Co-Author: Nothing to Disclose

Yojiro Matsoka, Abstract Co-Author: Nothing to Disclose

Masataka Uetani MD, Abstract Co-Author: Nothing to Disclose

The purpose is to evaluate CT findings of hemorrhage extending along the pulmonary artery (PA) due to ruptured aortic dissection (AD) and its prognostic factors.

In 232 patients with Stanford type A AD, 21 patients (9.1%) (nine males and eleven females; aged 50-90 years, with a mean of 70.3 years) were diagnosed as having hemorrhage extending along the PA due to ruptured AD. In 21 patients, the non-enhanced and enhanced CT studies were reviewed retrospectively. All patients had acute type A AD; 12 patients with double-barreled (classic) AD and 9 patients with intramural hematoma (IMH) (closed false lumen) of the aorta. CT images of hemorrhage extending along the PA, its complication, and early prognosis were observed. Based on CT findings, hemorrhage was classified into three categories as follows: category 1 (IMH of the PA or blood localized around the PA), category 2 (hemorrhage extending into the interlobular septa), and category 3 (hemorrhage extending into the alveoli). The factors influencing prognosis, including CT features and patient’s characteristics, were evaluated by univariate analysis and a multivariate logistic regression model.  

Seven (33.3%) of the 21 patients died within 72 hours of the onset due to heart and/or respiratory failure. In regard to extent of hemorrhage, 12 cases (57.1%) were classified into category 1, 2 cases (9.5%) category 2, and 7 cases (33.3%) category 3. On CT imaging, the aortic rupture site was identified in 9 cases (42.9%) and all of them were located at a posterior or a posteriomedial portion of the proximal ascending aorta, adjacent to the pulmonary trunk . Double- barreled AD and category 3 in extent of hemorrhage were the significant risk factors for death in univariate analyses. In multivariate analyses, presence of category 3 in extent of hemorrhage was only significant risk factor for death.   

 Extravasated blood from a ruptured aorta can dissect the bronchovascular sheaths and flow into the pulmonary interstitium and/or alveoli with increasing pressure. CT findings indicative of a poor prognosis include double-barreled type AD and category 3 in extent of hemorrhage. Hence, these findings may necessitate emergent surgery.  

CT findings indicative of a poor prognosis include double-barreled type AD and category 3 in extent of hemorrhage. The presence of these findings necessitates emergent surgery.  

Sueyoshi, E, Sakamoto, I, Matsoka, Y, Uetani, M, CT and Clinical Features of Hemorrhage Extending along the Pulmonary Artery Due to Ruptured Aortic Dissection.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6009084.html