Intramural hematoma

Fig. 5.23a-c. Carotid dissection. While the characteristic intramural hematoma is easily recognized as bright on TOF-MRA source images (a) and MIP (b), CE-MRA (c) outlines the long high grade stenosis of the distal extracranial vessel, but not the hematoma itself... 

Intramural hematoma of the ascending aorta has been reported in a cocaine user (86). 

Sassi C. Cocaine-induced intramural hematoma of the ascending aorta. Tex Heart Inst J 2001 28(3) 218-9. 109. 

Salomez, D., Ponette, E., van Steenbergen, W. Intramural hematoma of the esophagus after variceal sclerotherapy. Endoscopy 1991 23 299 - 301... 

The thoracic aorta may be affected by several different diseases, such as aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aneurysms and traumatic injury. Any of these diseases may well be displayed in the axial slices, as well with post-processing (Takahashi and Stanford 2005). Volume rendering in particular is helpful in displaying the anatomical situation of the thoracic aorta after stent graft placement (Fig. 15.7). 

For Stanford type A aortic dissection or type A intramural hematoma, accurate diagnosis is urgently needed because in such cases early surgical repair should be considered, whereas the majority of patients with uncomplicated typeB aortic dissection or intramural hematoma can be treated succsessfully with medical therapy. For acute type A aortic dissection time is very important for diagnosis and treatment because it is difficult to predict when it will rupture. (Yoshida et al. 2003). Multislice CT will not only detect aortic dissections and intramural hematomas, but will also assess the extent of its involvement. Devices with 16 rows or more will nearly overcome aortic motion arte-... 

Yoshida S, Akiba H, Tamakawa M, Yama N, Hareyama M, Morishita K, Abe T (2003) Thoracic involvement of type A aortic dissection and intramural hematoma diagnostic accuracy-comparison of emergency helical CT and surgical findings. Radiology 228 430-435... 

The penetrating aortic ulcer (PAU) is defined as a type IV lesion of the aortic wall (Task Force of the European Society of Cardiology 2001). By definition, it is an ulcerating atherosclerotic lesion, which breaks through the inner elastic membrane of the media and may lead to an intramural hematoma (IMH). In many cases, there are multiple ulcers of diameters up to 25 mm and an expansion up to 30 mm deep into the aortic wall (SuNDT 2002). They are often accompanied by atherosclerotic aneurysms of the abdominal aorta. The PAU can be seen in CTA as a contrast-enhanced bulge of the aortic wall (spurious aneurysm). Additionally,... 

Robbins RC, McManus RP, Mitchell RS, Latter DR, Moon MR, Olinger GN, Miller DC (1993) Management of patients with intramural hematoma of the thoracic aorta. Circulation 88 111-10... 

Sundt TM (2002) Management of intramural hematoma of the ascending aorta still room for debate. J Thorac Cardiovasc Surg 124 894-895... 

Because of the retroperitoneal location of the duodenum and its close proximity to the pancreatic head, secondary inflammatory changes with oedema and mural thickening of the duodenal loop may result from adjacent acute pancreatitis (Fig. 9.11). Severe pancreatitis can also cause intramural duodenal hematoma (Abbas et al. 2002), and indeed in this situation thickening of the duodenal wall may lead to symptoms of bowel obstruction. Pancreatic pseudocyst following acute pancreatitis may also cause... 

Abbas MA, Collins JM, Olden KW (2002) Spontaneous intramural small-bowel hematoma imaging findings and outcome. Am J Roentgenol 179 1389-1394... 

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