Hemorrhagic infiltration of the aortopulmonary adventitia: A complication of acute aortic dissection

Background: Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute aortic dissection, most frequently Stanford type A. The radiological interpretation of this finding may be a diagnostic challenge. The objective of this multicenter case series is to review the radiological and pathological findings of hemorrhagic infiltration of the aortopulmonary adventitia secondary to acute aortic dissection, and to describe the pathophysiology underlying this complication.

Material and methods: The study includes 20 cases of aortic dissection with hemorrhagic infiltration of the aortopulmonary adventitia. These are 17 cases with computed tomography (CT) data obtained from 5 academic centers. Three other cases were retrieved through a search of autopsy reports. Clinical, radiological and pathological data were collected.

Results: Linear foci of moderately increased attenuation were seen along the wall of the proximal pulmonary arteries in 4 cases on unenhanced CT. Contrast-enhanced CT showed soft-tissue thickening along these walls in all imaging cases, with some degree of narrowing of the lumen of the pulmonary arteries. Peribronchovascular ground-glass opacities or consolidation were present in 4 cases.

Conclusion: Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute type A aortic dissection. The radiologist should be aware of its pathophysiology and imaging findings in order to make a prompt diagnosis in an urgent setting.