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Case Reports
. 2024 Mar 15;19(1):133.
doi: 10.1186/s13019-024-02598-x.

Evaluation of intramural hematoma: a novel use of 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging

Fan Yang  1 , Yuanwei Chen  2 , Yongrong Zhou  3 , Dan Shao  3 , Jianfang Luo  4
Affiliations
Case Reports

Evaluation of intramural hematoma: a novel use of 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging

Fan Yang et al. J Cardiothorac Surg. .

Abstract

Background: Aortic intramural hematoma (IMH) is one of the typical entities of acute aortic syndrome and probably accounts for 5-25% of all cases. The ulcer-like projections (ULP), which are described as a focal, blood-filled pouch protruding into the hematoma of the aortic wall, are regarded as one of the high-risk imaging features of IMH and may cause initial medical treatment failure and death.

Case presentation: We present a case report of an acute type B IMH patient with impaired renal function and newly developed ULP in the acute phase. The 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MR) was performed to evaluate the condition of aortic hematoma. The 18F-FDG focal uptake along the aortic wall of the hematoma was normal compared to the background (SUVmax 2.17; SUVSVC 1.6; TBR 1.35). We considered the IMH stable in such cases and opted for medical treatment and watchful observation. Six months after discharge, the patient's recovery was satisfactory, and aortic remodeling was ideal.

Conclusions: The 18F-FDG PET/MR is a novel tool to evaluate the risk of IMH patients and thus provides information for therapy selection.

Keywords: 18F-FDG PET/MR; Intramural hematoma; Risk evaluation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The urgent contrast-enhanced computed tomography image on admission shows intramural hematoma of the descending aorta. A The section of the maximal aortic diameter (line). B The section of maximal hematoma thickness (line). C Sagittal contrast-enhanced computed tomography shows intramural hematoma of the descending aorta (star)
Fig. 2
Fig. 2
18F-fluorodeoxyglucose positron emission tomography/ magnetic resonance imaging. A Magnetic resonance imaging shows intramural hematoma with newly developed ULP on the arch (arrow). B The metabolism of the aortic wall was assessed by 18F-fluorodeoxyglucose positron emission tomography. C Fusion image of intramural hematoma
Fig. 3
Fig. 3
The contrast-enhanced computed tomography image shows the hematoma was significantly resolved and the ULP on the aortic arch disappeared after three months. A The transverse section of the aortic arch. B The section of the maximal aortic diameter (line). C Sagittal contrast-enhanced computed tomography shows resolved intramural hematoma of the descending aorta
See this image and copyright information in PMC

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