Ko Sheung-Fat, Lu Chia-Yin, Sheu Jiunn-Jye, Yip Hon-Kan, Huang Chung-Cheng, Ng Shu-Hang
Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan.
Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights Imaging. 2020 May 24;11(1):73. doi: 10.1186/s13244-020-00880-9.
This retrospective study evaluated the computed tomography (CT) features and clinical implications of a novel broken-crescent sign in patients with acute aortic intramural hematoma (IMH).
Out of 104 patients with aortic IMH encountered in our institution between 2003 and 2018, nine patients exhibited a positive broken-crescent sign, which was defined as a focal defect within the hyper-attenuating crescentic IMH on unenhanced CT, corresponding to a smooth out-bulging of the aortic lumen on enhanced study. The clinical findings, CT features, and outcomes of these nine patients were analyzed.
Of five males and four females (age range 48-84 years, mean 69.7 years), six had type A and three had type B IMH. Five patients who had medical treatment and stable status for 1 to 3 days suffered sudden death, two of whom showed ascending aortic rupture with hemopericardium in one and adventitial tear with outward spillage of IMH in another at follow-up CT. The other four patients had early surgical or endovascular management survived; two demonstrated ascending aorta ecchymosis with adventitial tear and intact intima at surgery. Our results support the supposition that aortic IMH complicated with adventitial tear and partial outward seepage of IMH may generate a broken-crescent sign in CT. Despite initially stable clinical status, the residual intact inner aortic wall carries a high risk of sudden aortic rupture.
In patients with acute aortic IMH, identification of a broken-crescent sign in CT is highly suggestive of impending aortic rupture, and early aggressive treatment is mandatory.
本回顾性研究评估了急性主动脉壁内血肿（IMH）患者中一种新型破裂新月征的计算机断层扫描（CT）特征及临床意义。
2003年至2018年期间，在我们机构收治的104例主动脉IMH患者中，9例表现为阳性破裂新月征，其定义为平扫CT上高密度新月形IMH内的局灶性缺损，在增强扫描时对应主动脉管腔的光滑向外膨出。分析这9例患者的临床发现、CT特征及预后。
5例男性和4例女性（年龄范围48 - 84岁，平均69.7岁），6例为A型IMH，3例为B型IMH。5例接受内科治疗且病情稳定1至3天的患者突然死亡，其中2例在随访CT中，1例显示升主动脉破裂伴心包积血，另1例显示外膜撕裂伴IMH向外溢出。其他4例接受早期手术或血管内治疗的患者存活；2例在手术时显示升主动脉瘀斑伴外膜撕裂但内膜完整。我们的结果支持这样的推测，即主动脉IMH合并外膜撕裂及IMH部分向外渗漏可能在CT上产生破裂新月征。尽管最初临床状态稳定，但残留完整的主动脉内壁仍有很高的主动脉突然破裂风险。
在急性主动脉IMH患者中，CT上识别出破裂新月征高度提示即将发生主动脉破裂，早期积极治疗是必要的。
