Chest and cardiac imaging: aortic intramural haematoma: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest and cardiac imaging: aortic intramural haematoma

Sample item

A hypertensive man has tearing chest pain. Non-contrast CT shows crescentic high-attenuation thickening of the descending aortic wall, and after contrast there is no intimal flap or false lumen enhancement. What is the diagnosis?

AThrombosed saccular aortic aneurysmBClassic aortic dissection with patent false lumenCAortic intramural haematomaDPenetrating atherosclerotic ulcer

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Aortic intramural haematoma

Bleeding from vasa vasorum into the media produces a crescentic hyperdense wall on unenhanced CT, which is why a non-contrast scan is part of the aortic pain protocol. It is managed like dissection according to the Stanford type.

Option by option

A. Thrombosed saccular aortic aneurysm
A thrombosed aneurysm shows a widened aortic calibre with lower attenuation mural thrombus.
B. Classic aortic dissection with patent false lumen
A classic dissection shows an intimal flap and an enhancing true and false lumen.
C. Aortic intramural haematoma (correct)
Correct. Hyperdense crescentic wall thickening without a flap or enhancing lumen defines it.
D. Penetrating atherosclerotic ulcer
A penetrating ulcer appears as a contrast-filled outpouching through an atherosclerotic intima.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Aortic intramural haematoma. Bleeding from vasa vasorum into the media produces a crescentic hyperdense wall on unenhanced CT, which is why a non-contrast scan is part of the aortic pain protocol.

Why is "Thrombosed saccular aortic aneurysm" not the answer?

A thrombosed aneurysm shows a widened aortic calibre with lower attenuation mural thrombus.

Why is "Classic aortic dissection with patent false lumen" not the answer?

A classic dissection shows an intimal flap and an enhancing true and false lumen.

Why is "Penetrating atherosclerotic ulcer" not the answer?

A penetrating ulcer appears as a contrast-filled outpouching through an atherosclerotic intima.

What concept does this question test?

It tests Chest and cardiac imaging: aortic intramural haematoma in Radiology. It is managed like dissection according to the Stanford type.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest and cardiac imaging: aortic intramural haematoma?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.