PMC5773468_01
A) Coronal unenhanced computed tomography (CT) image shows a crescent-shaped thickening of the aortic wall (arrowheads) with greater attenuation than the lumen, and pericardial effusion (circles). B) Sagittal contrast-enhanced CT image shows a localized blood-filled pouch (arrow) protruding into the intramural hematoma from the aortic lumen, characteristic for ulcer-like projection. C) Intraoperative findings of 2 cm transverse-shaped intimal tear (arrow) identified above the non-coronary sinus.
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A contrast-enhanced computed tomography (CT) showed an aneurysm of the ascending aorta complicated by type A IMH, an ulcer-like projection (ULP) and pericardial effusion (Fig. 1A, B). HCA no intimal flap was evident, a fresh IMH placed 4 cm above the non-coronary sinus was evacuated and 2 cm transverse shaped intimal tear was identified (Fig. 1C). Hemiarch procedure associated with root replacement, using two-grafts techniques, was performed.
PMC5773468_02
A) Axial unenhanced computed tomography (CT) image shows a crescent-shaped thickening of the aortic wall (arrowheads) with greater attenuation than the lumen. B) Oblique contrast-enhanced CT image shows a localized blood-filled pouch (arrow) protruding into the intramural hematoma from the aortic lumen, characteristic for ulcer-like projection. C) Intraoperative findings of 1.5 cm linear-shaped intimal tear (arrow) just below the origin of innominate artery.
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The CT images showed the presence of an ULP in the ascending aorta 1 cm below the origin of brachiocephalic artery (Fig. 2A, B). HCA hematoma was evacuated, no intimal flap was detected and 1.5 cm linear shaped intimal tear was identified 1 cm below the origin of brachiocephalic artery (Fig. 2C). Hemiarch procedure associated to root replacement using two-grafts technique was performed; the postoperative course was uneventfully and the patient was discharged home on 13th POD.