Imaging of Thoracic Intercostal Artery Rupture during the Propagation of a Type B Acute Aortic Syndrome

Abstract

The natural history of an intramural hematoma (IMH) has not been completely defined. This is a case report of a 63-year-old woman, in whom imaging reveals intercostal artery rupture during the process of expansion of an IMH in a Type B acute aortic syndrome. This case demonstrates that intercostal artery rupture may act as a precursor for the transformation of IMH to a classical dissection. Interestingly, complete resolution of this condition is achieved through medical management.

Key Words

Aortic dissection - Vasa vasorum - Intramural hematoma

• References

• 1 Kaji S, Nishigami K, Akasaka T, Hozumi T, Takagi T, Kawamoto T. , et al. Prediction of progression or regression of type A aortic intramural hematoma by computed tomography. Circulation 1999; 100 (19 Suppl) II281-II286
• 2 von Kodolitsch Y, Csösz SK, Koschyk DH, Schalwat I, Loose R, Karck M. , et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 2003; 107: 1158-1163 . 10.1161/01.CIR.0000052628.77047.EA
• 3 Hata M, Hata H, Sezai A, Yoshitake I, Wakui S, Shiono M. Optimal treatment strategy for type A acute aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg. 2012 pii: S0022-5223(12)01392-X. doi: 10.1016/j.jtcvs.2012.11.015
• 4 Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV. , et al. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 2005; 111: 1063-1070 . 10.1161/01.CIR.0000156444.26393.80
• 5 Hirst Jr AE, Johns Jr VJ, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37: 217-279
• 6 Yamada T, Tada S, Harada J. Aortic dissection without intimal rupture: diagnosis with MR imaging and CT. Radiology 1988; 168: 347-352
• 7 Williams DM, Cronin P, Dasika N, Upchurch Jr GR, Patel HJ, Deeb MG. , et al. Aortic branch artery pseudoaneurysms accompanying aortic dissection. Part I. Pseudoaneurysm anatomy. J Vasc Interv Radiol 2006; 17: 765-771 . 10.1097/01.RVI.0000209217.94558.81
• 8 Hayashi H, Matsuoka Y, Sakamoto I, Sueyoshi E, Okimoto T, Hayashi K. , et al. Penetrating atherosclerotic ulcer of the aorta: imaging features and disease concept. Radiographics 2000; 20: 995-1005