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ECR 2013 / C-1275
Hemorrhagic infiltration of the pulmonary artery connective sheath: a complication of acute aortic dissection
Congress: ECR 2013
Poster No.: C-1275
Type: Educational Exhibit
Keywords: Haemorrhage, Dissection, Aneurysms, Computer Applications-Detection, diagnosis, Complications, CT-High Resolution, CT-Angiography, CT, Cardiovascular system, Arteries / Aorta, Anatomy
Authors: J. M. Guilmette1, C. Dennie2, A. Semionov 1, G. Gahide3, J. Pressacco1, R. Fraser4, M.-P. Cordeau1, C. Chartrand-Lefebvre1; 1Montreal, QC/CA, 2Ottawa, ON/CA, 3Sherbrooke, QC/CA, 4Montreal, CA/CA


Proposed mechanism


The suggested mechanism to explain this entity involves dissection with contained rupture of the ascending aorta and the formation of a hemorrhagic infiltration limited to the extravasation of aortic blood along the aortopulmonary connective sheath (usually a virtual space in a normal patient), with consequent compression of the pulmonary arteries. This vascular compression would result in distal edema with hemorrhage of the lung parenchyma.




Hemorrhagic infiltration of the common aortopulmonary connective in acute aortic dissection, primarily Stanford type A, is a rare complication and not well known by the radiological community.


So far, few attempts were made to provide a detailed description of the pathophysiology of this complication. We consider our research as the first study describing the radio-patho-physiology of hemorrhagic infiltration of the aortopulmonary sheath in acute aortic dissection with supporting pathological and radiological evidence. 


Early detection and recognition would allow to distinguish this entity from other acute diseases of the mediastinum, and could lead to appropriate management. 


MDCT is a quickly available diagnostic tool, which is relatively specific in cases of acute aortic dissection. MDCT may also be used for monitoring if necessary.


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