A 58-year-old man presents with acute tearing chest pain. Non-contrast CT shows a crescentic area of high attenuation within the wall of the ascending aorta. Contrast-enhanced images show no intimal flap and no enhancement of this crescent. Which is the most likely diagnosis?
- A Penetrating atherosclerotic ulcer
- B Intramural haematoma of the aorta ✓
- C Classic Stanford type A dissection
- D Mural thrombus overlying an aneurysm
Correct answer: B. Intramural haematoma of the aorta
Explanation
Acute intramural haematoma appears as a crescentic or circumferential zone of high attenuation in the aortic wall on non-contrast CT, caused by blood in the media. It does not enhance, has no intimal flap, and typically shows no internal flow. Classic dissection requires a visible intimal flap with a double channel, which is absent here. Mural thrombus is low attenuation and occurs within an aneurysmal lumen rather than as fresh high-attenuation blood confined to the wall.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.