Ide K, Uchida H, Otsuji H, Nishimine K, Tsushima J, Ohishi H, Kitamura S
Department of Radiology, Nara Medical University, Japan.
J Thorac Imaging. 1996 Winter;11(1):46-52. doi: 10.1097/00005382-199601110-00004.
Acute aortic dissection with intramural hematoma has been believed to have a good prognosis, but we have encountered the transition of this entity to a classic dissection or aneurysm. We report the serial computed tomography (CT) features in 27 cases of acute aortic dissection with intramural hematoma. Eleven patients (40.7%) developed a classic dissection or aneurysm during follow-up. Four patients (14.8%) showed transition to a classic dissection without resolution of the intramural hematoma; each had a dilated ascending aorta measuring > 5 cm in diameter on the initial CT. One case (3.7%) developed an enlarging aneurysm without resolution of the intramural hematoma. In 19 cases (70.4%), the hematoma resolved; among these 19, the aortic diameter was significantly larger (p < 0.01) than those in a normal control group. Two of these 19 later developed an aneurysm, and four developed a classic dissection. This entity often (40.7%; 11 of 27) required surgical intervention or periodic follow-up CT examinations, particularly with a dilated ascending aorta of > 5 cm in diameter.
壁内血肿型急性主动脉夹层一直被认为预后良好，但我们遇到过该类型转变为典型夹层或动脉瘤的情况。我们报告了27例壁内血肿型急性主动脉夹层的系列计算机断层扫描（CT）特征。11例患者（40.7%）在随访期间发展为典型夹层或动脉瘤。4例患者（14.8%）转变为典型夹层，壁内血肿未消退；初始CT显示升主动脉直径均>5 cm。1例患者（3.7%）发展为动脉瘤且壁内血肿未消退。19例患者（70.4%）血肿消退；这19例患者的主动脉直径明显大于正常对照组（p<0.01）。这19例中有2例后来发展为动脉瘤，4例发展为典型夹层。该类型常（40.7%；27例中的11例）需要手术干预或定期进行CT随访检查，尤其是升主动脉直径>5 cm时。
