Intramural Hematoma and Penetrating Ulcers: Indications to Endovascular Treatment

A+B. IMH (asterisk) with plaque ulceration/intimal disruption (arrow) in the mid part of the descending thoracic aorta in a patient with acute aortic syndrome. C+D. Complete reabsorption of the IMH 1 year after TEVAR.

A. Contrast-enhanced CT of a patient presenting with acute aortic syndrome showing type A-IMH (asterisk) with evolving dissection in the descending aorta. B. Multiplanar reconstruction of the CT in parasagittal orientation delineates small intimal disruption/plaque rupture as the initial site of the IMH (arrow, asterisk-IMH). C. Transesophageal echocardiography showing active bleeding from the aortic lumen into the hematoma (arrow). D. Result after TEVAR with stent-implantation into the distal arch. Note complete reabsorption of the type A-IMH, as well as near-total resolution of descending thoracic aortic IMH. E. TEVAR result shown by intraoperative TEE, showing elimination of flow into the IMH.

A. Penetrating aortic ulcer (arrow) in an acute aortic syndrome patient. B. Fused PET-CT image showing increased glucose metabolism within the PAU (arrow). C. Progression towards pseudoaneurysm formation (arrow) under medical treatment. D. Result after TEVAR with complete resolution of the ulcer.