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Aortic dissection without intimal rupture: diagnosis with MR imaging and CT
1Department of Radiology, Jikei University School of Medicine, Tokyo, Japan.
Abstract:
Fourteen patients with aortic dissection without intimal rupture were examined by means of magnetic resonance (MR) imaging, computed tomography (CT), or both. MR imaging showed a marginal high-intensity area along the aortic wall, while CT showed a nonopacified crescentic area along the aortic wall. These areas decreased in size within a short period and normalized after 1 year. Two autopsies demonstrated intramural hemorrhage without intimal tears. The dissected lumen seen in these cases is believed to represent intramural hemorrhage due to rupture of the vasa vasorum without intimal tear; this entity is believed to represent aortic dissection.
Insights
Aortic dissection can occur without intimal rupture, presenting as intramural hemorrhage. This condition, diagnosed via imaging and autopsy, resolves within a year.
Area of Science:
- Cardiovascular Imaging
- Vascular Surgery
- Diagnostic Radiology
Background:
- Aortic dissection is a serious condition often associated with intimal tears.
- The precise etiology and imaging characteristics of aortic dissection without intimal rupture require further elucidation.
Purpose of the Study:
- To investigate the imaging findings and natural history of aortic dissection presenting without intimal rupture.
- To correlate imaging findings with pathological evidence in cases of suspected intramural hemorrhage.
Main Methods:
- Retrospective analysis of fourteen patients with suspected aortic dissection without intimal rupture.
- Utilized magnetic resonance (MR) imaging and computed tomography (CT) for diagnosis.
- Correlated imaging findings with autopsy results in two cases.
Main Results:
- MR imaging revealed a marginal high-intensity area along the aortic wall.
- CT demonstrated a nonopacified crescentic area adjacent to the aortic wall.
- These abnormalities showed a decrease in size over time, normalizing within one year.
- Autopsies confirmed intramural hemorrhage without intimal tears.
Conclusions:
- Aortic dissection can arise from intramural hemorrhage due to vasa vasorum rupture, independent of intimal tears.
- Imaging findings of intramural hematoma are distinct and resolve over time.
- This entity represents a specific form of aortic dissection.