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Updated: Dec 4, 2025

Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta
Published on: September 8, 2023
[Imaging in acute aortic syndrome: not just dissection]
Donato Mele1, Massimiliano Rizzo2, Marco Campana3
1U.O.C. Cardiologia e Radiologia, Azienda Ospedaliero-Universitaria, Ferrara.
Insights
Acute aortic syndrome, including aortic dissection, intramural hematoma, and penetrating aortic ulcers, requires prompt diagnosis. This review focuses on the less-understood imaging findings of intramural hematoma and penetrating aortic ulcers for better patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Vascular Surgery
Background:
- Acute aortic syndrome encompasses aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcers (PAU).
- These conditions are life-threatening, necessitating rapid diagnosis and treatment.
- While AD imaging is well-established, IMH and PAU imaging findings, prognoses, and management strategies are less recognized.
Purpose of the Study:
- To review and discuss the imaging findings of IMH and PAU.
- To highlight the role of imaging techniques in diagnosing and managing IMH and PAU.
- To elucidate the prognostic implications of IMH and PAU based on imaging characteristics.
Main Methods:
- Literature review of studies focusing on imaging modalities for IMH and PAU.
- Analysis of imaging characteristics associated with IMH and PAU.
- Discussion of the impact of imaging findings on clinical management and treatment strategies.
Main Results:
- Detailed description of characteristic imaging findings for IMH and PAU across various modalities (e.g., CT, MRI, TEE).
- Comparison of imaging features differentiating IMH and PAU from classical AD.
- Emphasis on how specific imaging findings influence therapeutic decisions and patient prognosis.
Conclusions:
- Imaging plays a critical role in the early and accurate diagnosis of IMH and PAU.
- Understanding the nuances of IMH and PAU imaging is crucial for appropriate patient management.
- Further research into advanced imaging techniques may improve diagnostic accuracy and therapeutic guidance for these conditions.
Abstract:
Acute aortic syndrome includes three main pathological conditions: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU). These are life-threatening conditions, therefore early diagnosis and interventional/surgical treatment are fundamental for the survival of affected individuals. While anatomical findings of classical AD provided by imaging techniques are known to all cardiologists, imaging findings of IMH and PAU are less known, as are their prognostic implications and consequences on management and treatment strategies. This review aims to describe and discuss findings and role of imaging techniques in patients with IMH and PAU.
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