The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

Abstract

ObjectiveTo evaluate the potential value of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic intramural hematoma (AIH).MethodsFrom September 2002 to May 2005, a consecutive series of 15 patients with suspected aortic dissection (AD) underwent both IVUS imaging and spiral computed tomography (CT). Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.ResultsThe study group consisted of five males and one female with mean age of 66 years old. All of them had chest or back pain. In one patient, CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer (PAU), which were detected by IVUS. In another patient, CT mistaken a partly thrombosed false lumen as an AIH, whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen. In the four rest patients, both CT and IVUS made the diagnosis of AIH, however, IVUS detected three PAUs in three of them, only one of them was also detected by CT, and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.ConclusionsIVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH, particularly for diagnosing localized AIH, distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.

Modern diagnostics for type B aortic dissection

“…This technology is able to provide dynamic information regarding the true and false lumens and can detect false lumen thrombosis with higher sensitivity and specificity than TEE [ 26 ]. The IVUS procedure is especially useful to understand the precise mechanism of branch vessel compromise, evaluation of intramural hematoma and to identify the proximal entry tear [ 27 ]; however, IVUS is invasive and therefore its use in diagnosis and surveillance is limited.…”