Fatal Outcome Due to Pulmonary Arterial Intramural Hematoma Associated With Stanford Type A Acute Aortic Dissection: A Case Report

TL;DR

This case report describes a fatal outcome in a patient with Stanford type A aortic dissection complicated by pulmonary artery intramural hematoma and alveolar hemorrhage.

Contribution

The paper highlights PA-IMH as an underrecognized complication of AAD and emphasizes the importance of identifying alveolar hemorrhage via CT imaging.

Findings

PA-IMH was identified as a complication of Stanford type A AAD in a fatal case.

Alveolar hemorrhage was observed and linked to circulatory collapse and death.

CT imaging with lung window settings is recommended to detect alveolar hemorrhage in PA-IMH cases.

Abstract

Stanford type A acute aortic dissection (AAD) is associated with a poor prognosis. Pulmonary artery intramural hematoma (PA-IMH) is an underrecognized complication of AAD. Here, we report a case of an 86-year-old man diagnosed with Stanford type A AAD. During emergency transfer to a tertiary care center with cardiovascular surgical capabilities, the patient experienced a cardiac arrest during transport by an ambulance and was subsequently pronounced dead. Postmortem computed tomography (CT) revealed right PA compression and wall thickening consistent with PA-IMH. Additionally, associated ground-glass opacity in the right lower lobe suggested alveolar hemorrhage, likely contributing to circulatory collapse, followed by cardiac arrest and death. We identified two important clinical issues. First, in cases of AAD, PA-IMH should be considered a potential complication when contrast-enhanced CT reveals obstruction or stenosis of the PA. Second, some cases of PA-IMH may present with alveolar hemorrhage, an important prognostic factor of PA-IMH that should be identified using CT with lung window settings.

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