INTRAMURAL HEMORRHAGE OF THE THORACIC AORTA - DIAGNOSTIC EXPERIENCE WITH MAGNETIC-RESONANCE-IMAGING, COMPUTED-TOMOGRAPHY AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Purpose: Intramural hemorrhage (IMH) of the aorta is considered to be a possible preliminary stage to dissection. We report on our experienc e with MRI, CT, and TEE in the diagnosis as well as in the correct eva luation of the extent of an IMH. Method: Between 1983 and 1997 a total of 26 patients were examined using MRI (n = 13) and/or contrast enhan ced CT (n = 18) or TEE. The validation was effected in 17 cases throug h intraoperative or postmortem inspection and in the remaining cases e ither through continuous clinical or radiological monitoring (n = 6) o r through the depiction of the results in 2 different imaging procedur es (n = 3). Results: The correct diagnosis of an IMH was made on all e xamined patients with ail imaging modalities. In all cases, MRI enable d the correct identification of the affected aortic segments. Using CT the affected descending aorta was overlooked in one out of 15 cases; TEE failed in one out of two; cases of intramural hemorrhage in the ao rtic arch. A false positive diagnosis was made with CT in one out of 9 cases in the ascending aorta, and using sonography, this occurred in two out of 3 cases in the area of the aortic arch. Conclusion: Accordi ng to our experience, magnetic resonance imaging is the most accurate method for the diagnosis of an IMH.