CT diagnosis and destiny of acute aortic intramural hematoma

Giacomo Sica ^1* Gaetano Rea ¹ Roberta Lieto ¹ Mariano Scaglione ² Ahmad Abu-Omar ³ Giorgio Bocchini ¹ Federica Romano ¹ Salvatore Masala ² Stefania Tamburrini ⁴ Salvatore Guarino ¹ Candida Massimo ¹ Tullio Valente ¹

• ¹ Radiology Unit, Monaldi Hospital, Naples, Italy
• ² Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
• ³ University of British Columbia, Vancouver, British Columbia, Canada
• ⁴ ASL Napoli 1 Centro, Napoli, Italy

Acute aortic intramural hematoma (IMH) is a relatively uncommon but potentially life-threating aortic disease that can occur primarily in hypertensive and atherosclerotic patients. The course of IMH varies widely, with the condition either regressing, remaining stable, or progressing until it leads to outward rupture or intimal layer disruption, eventually resulting in overt aortic dissection. Therefore, poor prognostic computed tomography (CT) features must be promptly recognized and and reported by the radiologist. In emergency departments, readily accessible non-invasive CT angiography is crucial for achieving a rapid and accurate diagnosis, essential for appropriate management. As for Type A and B aortic dissection, surgery is typically recommended in Western countries for patients with Stanford Type-A IMH, as well as those experiencing irrepressible pain. For Stanford Type-B IMH patients without complications or an incessant pain, medical treatment is suggested but with imaging follow-up. In complicated Stanford Type B situations, Thoracic Endovascular Aortic Repair (TEVAR) is currently indicated. Aim of this review is to present pathophysiology, CT diagnosis and IMH fate, providing the reader CT image-based review of the CT diagnostic criteria, complications and associated critical prognostic findings of this rather rare aortic disease.