The value of narrow CT window settings in the recognition of subtle acute aortic intramural haematoma

Abstract

Four patients with acute aortic intramural haematoma are presented. In all patients the typical crescentic hyperdense rim within the aortic wall was not obvious on unenhanced CT when reviewed on standard mediastinal windows, but the hyperdense crescentic rim was well seen on narrow window settings. The findings suggest that all patients with a typical clinical presentation of acute thoracic aortic dissection who do not have a classical dissection on contrast-enhanced CT or a hyperdense intramural haematoma on standard mediastinal settings, should have the non-contrast scans reviewed on narrow window settings.

The Acute Abdominal Aorta

“…On CT, this feature is best seen as hyperattenuation (40-70 Hounsfield units) on precontrast images, particularly with the use of narrow window settings. 35 On MR imaging, precontrast T1-weighted or black blood images may be useful to show intramural blood products, which can be isointense or hyperintense to skeletal muscle, depending on the age of the hematoma (Fig. 8).…”

Multidetector-row CT evaluation of nontraumatic acute thoracic aortic syndromes

“…Il segno indispensabile per la diagnosi è la dimostrazione diretta della componente ematica intramurale in assenza di flap intimale, di frattura intimale e di ulcerazione della parete aortica. Con la TC, è l'esame di base a fornire i rilievi semeiologici più caratteristici, mostrando la patognomonica iperdensità spontanea dell'ematoma di recente formazione, associata ad ispessimento parietale ed a volte a dislocazione intraluminale di calcificazioni parietali [59]; dopo perfusione di MdC ev, l'ematoma appare ipodenso, con aspetto semilunare o ad anello. L'ematoma intramurale compare più spesso nella stessa parete ove generalmente si manifesta il falso lume della dissezione: l'ispessimento parietale, pertanto, viene rilevato sulla parete anterolaterale destra nell'aorta ascendente e postero- ty of the recently formed haematoma associated with wall thickening and at times intraluminal displacement of wall calcifications [59].…”

Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies

“…Sometimes, the hyperdensity of the rim is better appreciated using narrow window settings (Fig. 11); recommended values are W=180-200 HU and C=30 HU [26]. After contrast administration, there is no enhancement of the hematoma, which appears relatively hypodense.…”