Aortic intramural haematoma associated with pulmonary artery periadventitial haematoma

Description 

A 54-year-old man who has a medical history of untreated hypertension presented to the emergency department with sudden onset of back pain and sweat. His back pain suddenly started while he was washing the dishes. The pain was sharp, continuous and radiating to his chest. His vital signs were normal and physical examination revealed neither heart murmur nor pulse deficit. Laboratory test revealed elevated D-dimer level of 2.5 µg/mL (reference range <0.5 µg/mL), but normal troponin-T level. Electrocardiography was normal. Chest X-ray showed widened mediastinum.

Non-contrast enhanced and contrast-enhanced CT was obtained. Non-contrast enhanced CT showed crescentic high attenuation sign along the aortic wall from the ascending to the descending aorta (figure 1), whereas contrast-enhanced CT showed a hypoattenuating aortic wall, with no evidence of dissection (figure 2). The haematoma was extended along the aortopulmonary connective sheath (figure 3). The patient was transferred to...

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