Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
Am J Emerg Med. 2013 Oct;31(10):1538.e3-4. doi: 10.1016/j.ajem.2013.05.036. Epub 2013 Jun 20.
A 59-year-old woman presented to emergency department with sudden onset of chest tightness and shortness of breath. Laboratory test revealed elevated D-dimer (1558 ng/mL). The electrocardiogram revealed right axis deviation, S1Q3T3 pattern, and T-wave inversion in leads V1 to V6. Computed tomographic angiography (CTA) was performed with 64-slice computed tomography for suspicious of pulmonary embolism. Contrast-enhanced CTA showed no filling defect in the pulmonary arteries; however, luminal narrowing of the right pulmonary artery was noted. Nonenhanced computed tomographic scan showed smooth eccentric high attenuation change along the wall of main pulmonary artery and right pulmonary artery and also along the ascending and descending aorta. The high attenuation lesions in both of the aorta and pulmonary artery showed no contrast enhancement indicating presence of intramural hematoma (IMH). Based on the image findings, a diagnosis of type A aortic IMH with pulmonary artery extension, instead of chronic pulmonary embolism, was made. Follow-up CTA 3 months later showed much improved of the right pulmonary artery narrowing and nearly complete resolution of the IMH.
一位 59 岁女性因突发性胸闷和呼吸急促到急诊就诊。实验室检查显示 D-二聚体升高（1558ng/ml）。心电图显示电轴右偏、S1Q3T3 模式和 V1 至 V6 导联 T 波倒置。为疑似肺栓塞行 64 层螺旋 CT 计算机断层血管造影（CTA）检查。增强 CTA 显示肺动脉内无充盈缺损；然而，注意到右肺动脉管腔变窄。非增强 CT 扫描显示主肺动脉和右肺动脉以及升主动脉和降主动脉沿壁的光滑偏心性高衰减变化。主动脉和肺动脉中的高衰减病变均无对比增强，表明存在壁内血肿（IMH）。根据影像检查结果，诊断为 A 型主动脉 IMH 伴肺动脉延伸，而非慢性肺栓塞。3 个月后的随访 CTA 显示右肺动脉狭窄明显改善，IMH 几乎完全消退。
