Imaging description

Aortic intramural hematoma (IMH) results from rupture of the vasa vasorum and hemorrhage into the arterial media, which leads to weakening of the aortic wall, but absence of the intimal disruption that characterizes an aortic dissection [1]. Intramural hematoma of the thoracic aorta can be classified with the Stanford system similar to aortic dissections, with a Stanford type A involving the ascending aorta, and a Stanford type B involving the descending aorta.

Intramural hematoma can be diagnosed with echocardiography, CT, and MRI. Transesophageal echocardiography has been reported to have a sensitivity of up to 100% and specificity of 91%, and transthoracic echocardiography has a reported sensitivity range of 77–80%, although both of these modalities are operator dependent. CT and MR also have a sensitivity and negative predictive value which approach 100% [1, 2], but because it is less time-consuming and typically more readily available than MR, CT has become the diagnostic test of choice in suspected acute aortic syndrome (AAS).