Dr. Pepe’s Diploma Casebook: Case 15 – SOLVED!

 

Dear Friends,

I have decided to show you a nice case before your Christmas holidays. Enhanced axial CT of a 69-year-old man with bone pain.


Fig. 1

Diagnosis:
1. Aortic dissection
2 Intramural hematoma
3. Fibrosing mediastinitis
4. None of the above

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12 Responses to : Dr. Pepe’s Diploma Casebook: Case 15 – SOLVED!

  1. Kelvin says:

    Confluent regular high attenuation mural thickening involving the aorta, without surrounding peri-aortic fat stranding. The thickening seems to be eccentric at the arch, and more concentric at the descending thoracic aorta.

    No intimal flap is seen.

    This does not appear to enhance (although we have to see the pre-contrast sequence to confirm this).

    The features are mostly suggestive of aortic intramural haematoma, as opposed to aortitis (the latter usually shows peri-aortic fat stranding, and is usually more segmental).

  2. DAG says:

    Fibrosing mediastinitis

  3. daca says:

    2.Intramural hematoma.

  4. Dr Hesham Alfetiani says:

    Fibrosting mediate its

  5. Xose says:

    Periaortitis
    It goes with systemic simphoms.

  6. Genchi Bari Italia says:

    Vi è una prima osservazione di tipo clinico:la dissecazione aortica, insieme all’ematoma intramurale, fanno parte conl’ulcera aterosclerotica della SAA( Sindrome Aortica Acuta) che non è riportato nel soggetto che invece si lamenta di un dolore osseo!.In secondo luogo è l’imaging che esclude queste due patologie, non dimostrando il”flap” intimale nella dissezione ed i segni( es.placche calcifiche…) dell’amatoma intramurale, di cui non si dimostra l’esame precontrasto.Si dimostra invece una presenza di T.solido iperintenso, “localizzato”in sede medio-posteriore ove si osserva un lume eofageo pervio, cranialmente e che poi si riduce a 2 piccole bolle aeree in un esofago a pareti ispessite.In vicinanza dell’esofago, si intravede un tramite ipointenso, probabilmente fistoloso; adenopatia all’angolo di divisione della polmonare. CD Tumore esofageo, fistolizzato, con mediatinite localizzata e metastatizzato all’osso(dolore osseo!).

  7. Maria says:

    Nothing of the above. There is a perivertebral mass that I believe is assosiated to the imaging finding of aorta (aortitis?).

  8. CARLO says:

    Erdheim-Chester disease
    Bone pain is the most frequent symptom.
    Soft tissue infiltration of the aortic arch.

    Infiltration may occur around the pulmonary arteries, superior vena cava, pericardium.
    it is possible pericardial effusion and pulmonary oedema.
    OK?

  9. Genchi.Italia says:

    Dove sono le alterazioni “ossee”., della Erdheim-Chester?.Non sono state allegate nella TC!

  10. RadLex says:

    Post-contrast CT angiogram of the thoracic aorta.
    There is haemorrhage within the aortic wall with no intimal tear (a pre-contrast scan is necessary to confirm this). It maintains a circumferential relationship with the aortic lumen. The aortic lumen is not compressed. No aortic calcifications are present.
    Appearance is in keeping with an aortic intramural haematoma. Pre-contrast CT is required for confirmation of this finding and exclusion of aortic dissection (intramural haematoma is thought to be a precursor of this entity).

  11. Herbert Kaufman DO says:

    Wonderful discussion and differential diagnosis. Many thanks.

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