Abstract：Objective: To study the mechanism, CTA findings and clinical implications of pulmonary arterial wall hematoma secondary to ruptured aortic dissection. Methods: We studied 183 patients with nontraumatic aortic dissection from 2007 to 2010 in our hospital, diagnoses were confirmed by CT angiography. CTA findings, treatment modalities and clinical outcomes were retrospectively analyzed in three patients with pulmonary arterial wall hematoma secondary to ruptured aortic dissection. Results: These 3 patients presented with chest pain on admission. CTA findings included: the intimal tear located in the proximal portion of ascending aorta extending to thoracic-abdominal aorta in one case, aortic arch extending only to ascending aorta in the second case and in the distal portion of aortic arch involving thoracic-abdominal aorta in the third case. The size of tear was 0.9cm, 0.8cm and 0.4cm respectively. The hematoma located in the wall of pulmonary arterial trunk in one case, in the wall of pulmonary artery trunk and bilateral pulmonary arteries in one case, in the wall of pulmonary artery trunk with bilateral pulmonary arteries and alveloar bleeding occurred in one case. On follow-up, the patient who underwent surgery survived now, while the other patients with conservative management deceased within 48 hours in hospital. Conclusion: CTA not only establishes the diagnosis of aortic dissection, but also defines the existence and extension of pulmonary arterial hematoma from the ruptured aortic dissection. According to our data and literatures review, patient's age and the extension of pulmonary arterial hematoma are important factors which affect patient's prognosis.
2011, Vol. 22 
