PMC3389901_01
Case 1. (A) CTA at the time of admission, presenting a dilatation of the thoracic aorta with hypodense wall thickening (arrows). Note the small area of atelectasis adjacent to the descending aorta, and the fluid in the left pleural cavity. (B) CTA performed seven days later, revealing an acute dissection of the ascending aorta. (C) Angiography image taken after the stent-graft implantation.
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CT revealed an extensive hypodense thickening of the aortic wall (Figure 1A). The second CTA revealed an aortic dissection and a slight increase of the primary lesion size, which appeared to be a type A IMH (Figure 1B). The patient was successfully treated by a combined surgical-endovascular method: ascending aorta grafting followed by a stent-graft implantation into the descending aorta, which gave a positive clinical outcome (Figure 1C).
PMC3389901_02
Case 2. (A) Non-enhanced scan at the time of admission, presenting a hyperdense lesion in the lumen of the descending aorta (arrow). (B) Contrast-enhanced CTA confirms well-defined crescent wall thickening of the descending aorta. (C) CTA performed 6 hours later showed a hemorrhage into the left pleural cavity.
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Contrast-enhanced scans revealed a 11-mm hypodense crescent-shaped wall thickening of the descending aorta, which was hyperdense before contrast administration (Figure 2A, B). However, during preoperative period, the hematoma ruptured, resulting in a fatal massive hemorrhage into the left pleural cavity (Figure 2C).