Atypical patterns in the CT diagnosis of aortic dissection

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M P Williams1, R Farrow

  • 1Department of Diagnostic Imaging, Derriford Hospital, Plymouth.

Clinical Radiology
|October 1, 1994
PubMed

Insights

Aortic dissection can present atypically on CT scans as intramural hematomas. These may evolve into penetrating atheromatous ulcers, complicating diagnosis.

Area of Science:

  • Cardiovascular Imaging
  • Diagnostic Radiology
  • Thoracic Surgery

Background:

  • Aortic dissection is a serious condition often diagnosed via CT.
  • Typical CT findings of aortic dissection are well-established.
  • Atypical presentations can pose diagnostic challenges.

Purpose of the Study:

  • To describe eight cases of aortic dissection with unusual CT appearances.
  • To highlight the role of intramural hematoma in atypical dissections.
  • To explore the potential evolution of intramural hematomas.

Main Methods:

  • Retrospective review of eight cases with atypical CT findings suggestive of aortic dissection.
  • Clinical diagnosis in seven cases, surgical confirmation in one.
  • Detailed analysis of CT imaging features, focusing on intramural hematoma characteristics.

Main Results:

  • All cases demonstrated intramural hematoma, often crescentic in shape.
  • The hematoma did not always compress the aortic lumen.
  • Seven cases were diagnosed clinically, one surgically confirmed.
  • Evidence suggests intramural hematomas can ulcerate, mimicking penetrating atheromatous ulcers.

Conclusions:

  • Intramural hematoma is a key feature in atypical aortic dissections.
  • The CT appearance of intramural hematoma can vary significantly.
  • Recognizing these atypical features is crucial for accurate diagnosis and management of aortic dissection and related pathologies.

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