Natural history of spontaneous aortic intramural hematoma progression: Six years follow-up with cardiovascular magnetic
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CASE REPORT
Natural history of spontaneous aortic intramural hematoma progression: Six years follow-up with cardiovascular magnetic resonance Case report
Xiaohai Ma*, Zhaoqi Zhang, Zhanming Fan, Lei Zhao and Jing Yu
Abstract We described a 6 years follow-up of a spontaneous aortic intramural hematoma (IMH) with cardiovascular magnetic resonance (CMR) examination. Since multiple factors may play roles in the natural history of IMH, the patient experienced the course of progression, which included hematoma absorption, ulcer-like lesion, aneurysm and limited dissection. The initial and follow-up CMR examination included 3D CE MRA and non-enhanced "bright blood" pulse sequence. The inherent advantage of outstanding contrast with plain scan, which shorten the scan time and avoid potential risk of contrast agent, might make the fast gradient echo sequence as an alternative method when following stable IMH. Background Spontaneous aortic intramural hematoma (IMH), which first described in 1920 by Krukenberg as "dissection without intimal tear", results from the spontaneous rupture of the vasa vasorum of the aortic wall. IMH most frequently involves the ascending aorta (type A) or proximal descending aorta (type B). This condition presents clinically as severe chest pain radiating to the back, which is similar to aortic dissection (AD). Systemic hypertension is the leading risk factor for spontaneous IMH. Recent advances in imaging techniques have significantly improved the diagnostic accuracy and enhanced clinical understanding of IMH. The natural history of spontaneous IMH is different from classical AD and its time course of IMH can vary significantly, so early diagnosis and close follow-up is desirable. We describe a spontaneous IMH case followed for 6 years by cardiovascular magnetic resonance (CMR). The patient progressed through different stages, including hematoma absorption, ulcerlike lesion emergence, aneurysm enlargement and limited AD.
* Correspondence: [email protected] 1
Deptartment of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
Case History A 65-year-old female with a long history of hypertension was referred to emergency room because of acute chest pain that persisted over one day. The echocardiogram showed a widening of the lumen of the ascending aorta. A thoracic aorta CMR examination (Siemens Sonata 1.5T, Erlangen, Germany) was performed for further evaluation. The imaging protocol included three-dimension contrast-enhanced magnetic resonance angiography (3D CE MRA, TR/TE 2.2/0.8; FOV 320 × 380 mm; effective thickness 1.23 ± 1.60 mm) and true fast imaging steadystate precession (true FISP) MRI (TR/TE 3.2/1.6 ms; field of view (FOV), 300 × 400 mm; matrix, 300 × 512; thickness, 6 mm). The true FISP images were acquired without cardiac gating. A stack of two-dimensional images were acquired in approximately 15~18 seconds. Each acquisition had 10 slices. Gadopentetate dimeglumine (0.1 mmol/kg, Magnevist, Bayer-Schering, Germany) was administrated
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