ABSTRACT
OBJECTIVE: To assess the long-term evolution and predictive factors of type B intramural hematoma (IMH). MATERIAL AND METHODS: 34 patients (33 men), mean age: 67 years (47-87) diagnosed with type B IMH by computed tomography (CT) and followed up clinically and by CT yearly. Mean follow-up was 5.9 years (2-13 years). Two evolution patterns were considered: (a) regression and (b) progression. Clinical and imaging variables were analyzed for assessing their predictor values. RESULTS: Evolution at one year was to regression in 56% and to progression in 44% of cases. There were no association among age, sex, other aortic abnormalities, presence of atherosclerotic disease or blood pressure, initial maximum aortic diameter, indexed maximum aortic diameter, IMH thickness or length, presence or absence of mediastinal hematoma and the evolution of type B IMH. Ten patients had small aortic ulcers in the acute phase. The presence of ulcers was related with progression of IMH. No differences were observed in evolution between the control at first year and the last control. CONCLUSIONS: The presence of small ulcers is a strong predictor of evolution in acute type B IMH. In addition, the regression group remains completely stable after the first year of evolution.
Subject(s)
Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Dissection/diagnostic imaging , Hematoma/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Aortic Dissection/pathology , Aorta, Abdominal , Aortic Aneurysm, Thoracic/pathology , Chi-Square Distribution , Contrast Media , Disease Progression , Female , Hematoma/pathology , Humans , Male , Middle Aged , Predictive Value of Tests , Proportional Hazards Models , Statistics, NonparametricABSTRACT
We report 2 patients with Budd-Chiari (BC) syndrome secondary to thrombogenic conditions who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement because of refractory ascites and impending liver failure. After TIPS placement, there was marked symptomatic relief and improvement in liver function, but the courses of both patients were complicated by the development of an inferior vena cava (IVC) syndrome caused by segmental stenosis of the suprahepatic IVC just at the outflow jet of the TIPS at 11 and 9 months later. One patient underwent liver transplantation, and the other patient, caval angioplasty and stenting. Stenosis of the IVC represents an unrecognized complication of TIPS in patients with BC syndrome.
