0:00

Here's our fourth case.

0:03

I'm showing a transaxial non-ecgated.

0:08

non contrast CT through

0:11

the chest

0:12

This one was just over a

0:15

year ago, March of 2020.

0:18

See if you can identify the abnormalities on

0:21

this single image.

0:29

And if you can identify the abnormalities, can you

0:32

come up with a diagnosis?

0:35

Okay, the important thing here is that this

0:38

is a non contrast study.

0:40

We see some clear abnormalities in

0:43

the posterior. Thorax. There's a

0:46

small left plural effusion. There's a

0:49

trace right flow effusion. Looks like there's probably some airspace disease

0:52

in the right lung base as well

0:55

as some airspace disease or atelectasis in

0:58

the left, lung base.

1:00

Those are important observations, but the primary observation here.

1:03

Is this Crescent of high density

1:06

within the wall.

1:09

of the descending thoracic table

1:14

This is so important a diagnosis that

1:17

I'm showing you for the second time in four cases

1:20

an example of intramural hematoma.

1:25

This is what it looks like on a non-contrast study. It's

1:28

high density. Usually about 50

1:31

to 70 House Field units

1:34

and it's clearly distinct from aluminum in

1:37

our protocol for suspected

1:40

acute aortic injury. We

1:43

have a non-contrast series many other people do

1:46

the same and it's because sometimes you can see intramural

1:49

hematomas to better advantage on

1:52

the non contrast series and because

1:55

they're so subtle post contrast awesome and

1:58

because it's so important not to miss them.

2:02

We really have to be diligent about looking at the aorta in

2:06

as many ways as possible. This is a type B lesion.

2:09

And type B is considered non-surgical unless as

2:12

time passes something

2:15

changes with

2:18

the morphology of the aorta, for example, it

2:21

converts to the section or an aneurysm

2:24

forms.

2:26

And in that case stanting may be an appropriate

2:29

an appropriate option in this case. The patient

2:32

actually did have conversion.

2:35

a month later

2:37

to

2:39

a type B dissection

2:42

However, it was still managed medically and

2:45

a year later or seven months later. We

2:48

see that the same patient has shown essentially complete

2:51

resolution of that acute aortic injury.