CONTENT

A 53-year-old man presented to the emergency department with sudden onset of compressive chest pain. Thoracic computed tomography (CT) with intravenous contrast showed a dissection flap (Stanford type A, DeBakey II dissection) in the ascending aorta, extending from the sinotubular junction to the origin of the brachiocephalic artery (Figure 1). Computed tomography sections also showed a circumferential hypodense appearance extending from the pulmonary trunk to the lobar branches, narrowing the vessel lumen, which was evaluated as an intramural hematoma. The patient underwent isolated ascending aortic graft interposition, and post-treatment control intravenous non-contrast CT images showed no increase in density in the pulmonary artery wall that could be related to the hematoma.

Pulmonary artery intramural hematoma (PA-IMH) is a rare complication with unclear clinical implications.^1,2 In aortic dissection, the progression of hematoma to the pulmonary artery wall is explained by the commonality of the ascending aorta and pulmonary trunk adventitia layers.² If hyperdancing of the pulmonary artery wall is detected on non-contrast CT, PA-IMH and thus acute aortic dissection should be considered. In case of high clinical suspicion, PA-IMH may be helpful in the differential diagnosis of aortic dissection.

It should be noted that no AI-enabled technologies, such as big language models or chatbots, were employed in the production of this work.

Footnotes

Informed Consent: The patient was informed about the details of the study and consent was obtained in accordance with the relevant ethical rules.

Declaration of Interests: The authors have no conflicts of interest to declare.

References

1. Moore AG, Eagle KA, Bruckman D. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: international Registry of Acute Aortic Dissection (IRAD). Am J Cardiol. 2002;89(10):1235-1238.
2. Farias LPG, Favaretto AC, Baptista LPS, Teles GBDS. Pulmonary arterial intramural hematom due to acute aortic dissection. Arq Bras Cardiol. 2021;116(6):1169-1171.