Images in vascular medicine: aortic intramural hematoma with dissection in aortic medial degeneration.

摘要

A 67-year-old man presented to the hospital after acute onset of chest pain. Echocardiography showed a pericar-dial effusion and an aortic dissection was suspected. Contrast-enhanced computed tomographic angiography depicted aneurysmal dilation of the ascending aorta measuring 5.5 cm in diameter. Furthermore, it revealed an inti-mal tear with outflow of contrast medium into the dissected anterior wall of the upper ascending aorta (Panel AI; arrow). This tear extended into an anterior intramural hematoma, reaching from the aortic arch to the aortic root (Panel A2; arrow). Pericardial effusion was also present. The arch vessels were not involved. Catheter angiography ruled out coronary artery disease and confirmed that the coronary arteries were neither dissected nor compressed by the intramural hematoma.