Intramural blood pools (IMBPs), also known as aortic branch artery pseudoaneurysms, are small foci of contrast enhancement within a recent aortic intramural hematoma seen on contrast-enhanced CTs 2. The IMBPs are more common in patients whose IMH thickness exceeds 10 mm.
IMBPs are located within the intramural hematoma and either do not visibly communicate with the true lumen, or do so via only a very small (< 2 mm) ostium 1. They are most frequently located within the descending thoracic and abdominal aorta in hematomas at least 10 mm in thickness 1. Additionally, they are often associated with an adjacent intercostal artery or lumbar artery 1. Less common aortic branches implicated include the bronchial arteries 2.
Treatment and prognosis
Unlike ulcer-like projections, intramural blood pool to not adversely affect prognosis, often spontaneously regress, and require no dedicated treatment 1. CTA follow up is important as occasionally endovascular coil embolization is offered to patients with enlarging symptomatic IMBPs 2.
- 1. Ming-Ting Wu, Yen-Chi Wang, Yi-Luan Huang, Ruey-Sheng Chang, Shang-Chieh Li, Pinchen Yang, Tung-Ho Wu, Kuan-Rau Chiou, Jer-Shyung Huang, Huei-Lung Liang, Huey-Ben Pan. Intramural Blood Pools Accompanying Aortic Intramural Hematoma: CT Appearance and Natural Course. (2011) Radiology. doi:10.1148/radiol.10101270
- 2. Ko JP, Goldstein JM, Latson LA, Azour L, Gozansky EK, Moore W, Patel S, Hutchinson B. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. (2021) Radiographics : a review publication of the Radiological Society of North America, Inc. 41 (2): 399-424. doi:10.1148/rg.2021200055 - Pubmed
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