Figure 8.

A 66-year-old male presented with acute chest pain. He was allergic to iodinated contrast media so initially underwent a non-contrast-enhanced CT angiogram (a), which shows the hyperdense rim of an intramural haematoma (IMH) in the descending aorta (arrow). MRI was performed to determine if the ascending aorta was involved, which is confirmed (horizontal arrows) with “black blood” half-Fourier acquisition single-shot turbo spin echo (b) and balanced steady-state free precession images (c). IMH has a similar natural history to dissection so is often treated in a similar manner, and this man underwent successful surgery with grafting of the ascending aorta.