Question 1619
{"accessible":true,"alternatives":[{"id":8062,"text":"aortic aneurysm rupture "},{"id":8063,"text":"aortic dissection"},{"id":8064,"text":"aortic intramural hematoma"},{"id":8065,"text":"penetrating atherosclerotic ulcer"},{"id":8066,"text":"uncomplicated aortic atheromatosis"}],"archived":false,"correctAlternativeId":8065,"explanation":"\u003cp\u003eThere is a contrast-filled\u0026nbsp;outpouching\u0026nbsp;of the wall of the descending aorta into the thickened aortic wall, consistent with penetrating atherosclerotic ulcer.\u003c/p\u003e\u003cp\u003eThis\u0026nbsp;lesion\u0026nbsp;may progress to an aortic intramural hematoma. Moreover, the most common mechanism of aortic intramural hematoma is spontaneous rupture of the vasa vasorum\u0026nbsp;rather\u0026nbsp;than from a penetrating atherosclerotic ulcer.\u003c/p\u003e\u003cp\u003eThe absence of a false lumen or an intimal flap rules out the diagnosis of aortic dissection.\u003c/p\u003e\u003cp\u003eThe thoracic aorta shows a normal diameter, so there is no aneurysm.\u003c/p\u003e\u003cp\u003eFinally, despite there is extensive aortic atheromatosis, however, the diagnosis of uncomplicated atheromatosis is incorrect both because of the radiological findings described above and because of the clinical presentation of an acute aortic syndrome.\u003c/p\u003e","id":1619,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/155/aorta_bueno_big_gallery.jpeg","imageAttribution":{"kind":"own","user_id":45033,"user_param":"edlomar","user_name":"Edgar Lorente"},"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2016","nextQuestionPath":"/articles/aortic-intramural-haematoma/questions/310","relatedArticles":[{"id":8884,"title":"Thoracic aortic aneurysm","link":"/articles/thoracic-aortic-aneurysm?lang=us"},{"id":931,"title":"Arteriosclerosis","link":"/articles/arteriosclerosis?lang=us"},{"id":12816,"title":"Penetrating atherosclerotic ulcer","link":"/articles/penetrating-atherosclerotic-ulcer?lang=us"},{"id":12392,"title":"Acute aortic syndrome","link":"/articles/acute-aortic-syndrome?lang=us"},{"id":39597,"title":"Aortic aneurysm","link":"/articles/aortic-aneurysm-1?lang=us"}],"alsoUsedIn":[{"id":629,"kind":"Course","title":"Radiopaedia 2020 - Lectures Only - page 629","link":"https://radiopaedia.org/courses/radiopaedia-2020-exclusive/pages/629"},{"id":629,"kind":"Course","title":"2020 Virtual Conference Private Use - page 629","link":"https://radiopaedia.org/courses/2020-virtual-conference-private-use/pages/629"},{"id":690,"kind":"Course","title":"Abdominal Emergency Radiology Course - page 690","link":"https://radiopaedia.org/courses/abdominal-emergency-radiology-course-online/pages/690"},{"id":690,"kind":"Course","title":"2020 Virtual Conference Private Use - page 690","link":"https://radiopaedia.org/courses/2020-virtual-conference-private-use/pages/690"}],"stem":"\u003cp\u003eThis 65-year-old woman presents with acute chest pain, mild troponin elevation and normal ECG. A thoraco-abdominal contrast-enhanced CT\u0026nbsp;scan\u0026nbsp;is performed.\u0026nbsp;What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1619"}],"attemptsPercentages":[{"alternativeId":"8063","percentage":21},{"alternativeId":"8065","percentage":37},{"alternativeId":"8066","percentage":3},{"alternativeId":"8064","percentage":29},{"alternativeId":"8062","percentage":11}],"promptToLogin":false,"questionManager":false,"articleId":"aortic-intramural-hematoma"}