Intramural hematoma

68 year old female presents to the ED after sudden onset of acute chest pain. Past history includes hypertension and coronary artery disease. EKG unchanged, so a CT angiogram of the chest was performed.

Conventional image shows thickening of the descending thoracic aorta. Virtual non-contrast shows the wall thickening has a density of approximately 55 HU. Straightforward diagnosis: this is an intramural hematoma, since it only involves the descending thoracic aorta, can be considered comparable to a type B aortic dissection.

Patient managed conservatively with aggressive management of blood pressure, with esmolol and clevidipine drips. Discharged on hospital day 6, after transition to PO meds.

Spectral CT can decrease radiation dose by reducing need for multiple CT series. We do not acquire a true non-contrast CT as part of aortic imaging, this case shows why it is unncessary.

Conventional CT: thickened wall of the descending aorta

Virtual non-contrast: The wall thickening has increased attenuation, diagnostic of an intramural hematoma.