Type B Intramural Hematoma of the Aorta: Evolution and Prognostic Value of Intimal Erosion

Schlatter, T.; Asselineau, Julien; Marcheix, Bertrand; Lebbadi, M; Marachet, M. A.; Dang-Tran, Kim-Diêp; Tran, Minhhoang; Honton, Benjamin; Gardette, Virginie; Rousseau, Hervé

doi:10.1016/j.jvir.2010.10.028

Cited by 30 publications

(7 citation statements)

References 16 publications

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“…23 Greater PAU diameter ($20 mm) and depth ($10 mm) have been associated with an increased risk for complications in several studies. [23][24][25] All patients with concomitant PAU underwent TEVAR after the first CTA scan (Supplementary Fig 2, online only). PAU is distinguished from ULP, which is not associated with atherosclerotic disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma

Bischoff

Meisenbacher

et al. 2016

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma

Bischoff

Meisenbacher

et al. 2016

Journal of Vascular Surgery

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“…Maximum hematoma thickness predicts adverse outcomes, with increased thickness decreasing the likelihood of complete resorption, as well as increasing the risk for progression, aortic dissection, need for surgery, and death (3,10,12,23,27,30,31). Hematoma thickness is typically based on axial measurements or measurements obtained perpendicular to the longitudinal axis of the aorta lumen, with suggested thickness cutoff values of 10-11 mm (Fig 9) (3,23,31).…”

Section: Maximum Imh Thicknessmentioning

confidence: 99%

“…Studies of intramural blood pool are limited, and the prognostic significance is uncertain. On the basis of current available literature, intramural blood pool does not appear to carry increased risk for IMH progression, need for surgery, or mortality but does have higher risk for incomplete hematoma resorption (23,30). Larger intramural blood pools and those with a visible connection to a contrast-enhanced CT images show an intramural blood pool (white arrow) with absent or a tiny communication with the true aortic lumen.…”

Section: Intramural Blood Poolmentioning

confidence: 99%

Emerging Concepts in Intramural Hematoma Imaging

Gutschow¹,

Walker²,

Martínez-Jiménez³

et al. 2016

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Intramural hematoma (IMH) is included in the spectrum of acute aortic syndrome and appears as an area of hyperattenuating crescentic thickening in the aortic wall that is best seen at nonenhanced computed tomography. IMH is historically believed to originate from ruptured vasa vasorum in the aortic media without an intimal tear, but there are reports of small intimomedial tears identified prospectively at imaging or found at surgery in some cases of IMH. These reports have blurred the distinction between aortic dissection and IMH and raise questions about what truly distinguishes the entities that compose acute aortic syndrome. The pathophysiology of these subgroups and the controversies surrounding their differentiation are discussed. The natural history of IMH is highly variable; it may resolve or progress to aneurysm, dissection, or rupture. The authors review various imaging prognostic factors that should be reported by the radiologist, including Stanford classification, maximum aortic diameter, maximum IMH thickness, focal contrast enhancement (including ulcerlike projection and intramural blood pool), and pleural or pericardial effusion. Medical (nonsurgical) versus surgical treatment strategies depend primarily on the Stanford classification, although more recent studies of Asian cohorts report success of initial medical treatment in patients with Stanford type A IMH, with timed (delayed) surgery for patients who develop complications. Understanding the imaging appearance and prognostic factors of IMH helps the radiologist and surgeon identify patients at greatest risk for complications to ensure appropriate treatment and improve patient outcomes. (©)RSNA, 2016.

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“…If luminal dilatation, penetrating ulcer, enlargement of the IMH or dissection occur, surgical or endovascular treatment should be considered. 55,56 Atypical MDCT findings of intramural haematoma The findings of a dissection-variant IMH are as follows: (a) A small intimal disruption defined as "primary intimal tear" or "ulcer-like projection/lesion" is a localized blood-filled pouch protruding from the TL into the thrombosed FL of the aorta (Figure 17). This finding is an indicator of the formation of a flow channel between the two lumens, which can become an AD or can heal and resolve.…”

Section: Intramural Haematomamentioning

confidence: 99%

MDCT evaluation of acute aortic syndrome (AAS)

Valente¹,

Rossi²,

Lassandro³

et al. 2016

BJR

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Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.

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Type B Intramural Hematoma of the Aorta: Evolution and Prognostic Value of Intimal Erosion

Cited by 30 publications

References 16 publications

Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma

Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma

Emerging Concepts in Intramural Hematoma Imaging

MDCT evaluation of acute aortic syndrome (AAS)

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