Prognosis of acute intramural hemotoma with whole aorta CTA

Objective: To observe the characteristics of acute intramural hematoma (IMH) and determine the predictive factors of evolution by CTA. Methods: Totally 221 consecutive patients with IMH were enrolled. The clinical data and the morphological characteristics of initial CTA were recorded. The follow-up CTA of patients with conservative therapy were performed regularly, and then the patients were divided into stable group and progressive group according to the evolution in one year. The clinical data and CTA findings were compared. And the risk factors of evolution were analyzed. Results: In 135 patients with conservative therapy after onset, 92 cases (7 cases with Stanford type A) were in stable group and 43 cases (10 cases with Stanford type A) were in progressive group. 14 patients were loss of follow-up in half a year. 73.76% (163/221) had the history of hypertension. The initial thickness of IMH, local enhancement, diameter of aorta, plural effusion and cardiac effusion had no difference between the two groups (all P>0.05), however the type of IMH, ulcer-like projection had significant difference (both P<0.05). The Logistic analysis showed the hypertension and ulcer-like projection were the progression risk factor of IMH. Conclusion: The type of IMH, ulcer-like projection and hypertension are the risk factors of evolution.