New development of an ulcerlike projection in aortic intramural hematoma: CT evaluation

To investigate the natural history and predictors of progression of a newly developed ulcerlike projection in patients with an aortic intramural hematoma.

Serial computed tomographic (CT) findings in 52 patients with intramural hematoma were reviewed. Sixteen patients had Stanford type A intramural hematoma, and 36 had Stanford type B. Diagnosis of intramural hematoma was established with CT. Regular follow-up studies were performed every week during the 1st month and two or three times a year after the 2nd month. The presence or absence of an ulcerlike projection, diameter and progression of the projection, and aortic diameter were evaluated. Relationships among ulcerlike projections, clinical data, and CT findings were analyzed.

In 17 (33%) of the 52 patients, 17 ulcerlike projections were newly identified during the follow-up period. Patients with type A intramural hematoma had a significantly higher frequency of new development of ulcerlike projection than that of patients with type B intramural hematoma (P =.002). In 17 patients with new development of ulcerlike projection, 12 (70%) of 17 projections progressed to complications such as enlargement (n = 10) or progression to overt aortic dissection (n = 2). One of 10 enlarged projections progressed to rupture. A significant predictor of progression of ulcerlike projection was based on location from the ascending aorta to the aortic arch with the use of univariate (P =.009) and multivariate Cox (P =.018) regression analyses.

The location of ulcerlike projections is the principal predictor of progression, and careful follow-up study is needed for patients with an ulcerlike projection located from the ascending aorta to the aortic arch.