CTICasesAortic Intramural Hematoma with Ulcer-Like Projection
[...]. Aortic Intramural Hematoma with Ulcer-Like Projection. CTICases. Published March 4, 2021. https://str-case-explorer.pages.dev/c/syyp7
Imaging findings
Sequential CT without and with contrast in a patient with known type B intramural hematoma (IMH) demonstrate a circumferential high-attenuation rind on non-contrast imaging. Follow-up CT shows development of a focal ulcer-like projection (ULP) with a broad neck arising from the IMH, along with a separate intramural blood pool, with overall aortic enlargement compared to the prior study.
Key takeaways
Ulcer-like projections (ULPs) are focal outpouchings of contrast that develop within an aortic intramural hematoma, representing contained focal disruption of the intima. They are associated with a markedly worse prognosis than IMH without ULPs, including higher rates of aortic expansion and rupture. ULPs mandate prompt consideration of endovascular repair, distinguishing them from simple IMH which may be managed medically.
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