Figure 2:

Images in a 72-year-old male patient (patient 2) undergoing coronary intervention for recanalization of a chronic total occlusion of the right coronary artery. (A) Coronary angiogram shows extravasation of contrast media recognized during the procedure (yellow arrow). The perforation was treated with immediate implantation of a covered stent. CT performed 1.5 hours after percutaneous coronary intervention showed a focal hyperattenuated layering of contrast media adjacent to the proximal right coronary artery, with additional intramural hematoma extending to the ascending aorta (Dunning III; yellow arrows on B, C, axial non–contrast-enhanced and D, contrast-enhanced CT images) and to the pulmonary arteries to the level of the lobar arteries of both lungs (yellow arrows on C, non–contrast-enhanced and D, contrast-enhanced CT images). Perivascular ground-glass opacities compatible with alveolar hemorrhage in this patient with hemoptysis were found in all pulmonary lobes, corresponding to extension of the hematoma to the alveoli (category III, according to Sueyoshi et al [13]; yellow arrows in E). Follow-up CT after 2 days revealed marked reduction of intramural hematoma of the aortic root and complete resolution of the intramural hematoma in the pulmonary trunk (yellow arrows) and lobar pulmonary arteries, along with F, a reduction of mediastinal hematoma and alveolar hemorrhage.