{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:03:05Z","timestamp":1760122985929,"version":"3.37.3"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T00:00:00Z","timestamp":1590278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T00:00:00Z","timestamp":1590278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Insights Imaging"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>This retrospective study evaluated the computed tomography (CT) features and clinical implications of a novel broken-crescent sign in patients with acute aortic intramural hematoma (IMH).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Out of 104 patients with aortic IMH encountered in our institution between 2003 and 2018, nine patients exhibited a positive broken-crescent sign, which was defined as a focal defect within the hyper-attenuating crescentic IMH on unenhanced CT, corresponding to a smooth out-bulging of the aortic lumen on enhanced study. The clinical findings, CT features, and outcomes of these nine patients were analyzed.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of five males and four females (age range 48\u201384 years, mean 69.7 years), six had type A and three had type B IMH. Five patients who had medical treatment and stable status for 1 to 3 days suffered sudden death, two of whom showed ascending aortic rupture with hemopericardium in one and adventitial tear with outward spillage of IMH in another at follow-up CT. The other four patients had early surgical or endovascular management survived; two demonstrated ascending aorta ecchymosis with adventitial tear and intact intima at surgery. Our results support the supposition that aortic IMH complicated with adventitial tear and partial outward seepage of IMH may generate a broken-crescent sign in CT. Despite initially stable clinical status, the residual intact inner aortic wall carries a high risk of sudden aortic rupture.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with acute aortic IMH, identification of a broken-crescent sign in CT is highly suggestive of impending aortic rupture, and early aggressive treatment is mandatory.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13244-020-00880-9","type":"journal-article","created":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T09:02:42Z","timestamp":1590310962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Broken-crescent sign at CT indicates impending aortic rupture in patients with acute aortic intramural hematoma"],"prefix":"10.1186","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-6999","authenticated-orcid":false,"given":"Sheung-Fat","family":"Ko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Yin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiunn-Jye","family":"Sheu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hon-Kan","family":"Yip","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Cheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu-Hang","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,24]]},"reference":[{"key":"880_CR1","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","volume":"127","author":"DP Howard","year":"2013","unstructured":"Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM (2013) Population based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 127:2031\u20132037","journal-title":"Circulation"},{"key":"880_CR2","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1001\/jama.2016.10026","volume":"316","author":"FF Mussa","year":"2016","unstructured":"Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA (2016) Acute aortic dissection and intramural hematoma: a systematic review. JAMA 316:754\u2013763","journal-title":"JAMA"},{"key":"880_CR3","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","volume":"35","author":"R Erbel","year":"2014","unstructured":"Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35:2873\u20132926","journal-title":"Eur Heart J"},{"key":"880_CR4","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1161\/01.CIR.0000052628.77047.EA","volume":"107","author":"Y von Kodolitsch","year":"2003","unstructured":"von Kodolitsch Y, Csosz SK, Koschyk DH et al (2003) Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 107:1158\u20131163","journal-title":"Circulation"},{"key":"880_CR5","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1148\/rg.293085122","volume":"29","author":"CP Chao","year":"2009","unstructured":"Chao CP, Walker TG, Kalva SP (2009) Natural history and CT appearances of aorticintramural hematoma. Radiographics 29:791\u2013804","journal-title":"Radiographics"},{"key":"880_CR6","doi-asserted-by":"publisher","first-page":"S292","DOI":"10.1161\/CIRCULATIONAHA.108.843615","volume":"120","author":"T Kitai","year":"2009","unstructured":"Kitai T, Kaji S, Yamamuro A et al (2009) Clinical outcomes of medical therapy and timely operation in initially diagnosed type A aortic intramural hematoma: a 20-year experience. Circulation 120:S292\u2013S298","journal-title":"Circulation"},{"key":"880_CR7","doi-asserted-by":"publisher","first-page":"2046","DOI":"10.1161\/CIRCULATIONAHA.109.879783","volume":"120","author":"J-K Song","year":"2009","unstructured":"Song J-K, Yim J-H, Ahn J-M et al (2009) Outcomes of patients with acute type A aortic intramural hematoma. Circulation 120:2046\u20132052","journal-title":"Circulation"},{"key":"880_CR8","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/1471-2261-14-103","volume":"14","author":"YJ Choi","year":"2014","unstructured":"Choi YJ, Son JW, Lee SH et al (2014) Treatment patterns and their outcomes of acute aortic intramural hematoma in real world: multicenter registry for aortic intramural hematoma. BMC Cardiovasc Disord 14:103. https:\/\/doi.org\/10.1186\/1471-2261-14-103","journal-title":"BMC Cardiovasc Disord"},{"key":"880_CR9","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.ehj.2003.10.011","volume":"25","author":"A Evangelista","year":"2004","unstructured":"Evangelista A, Dominguez R, Sebastia C et al (2004) Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma. Therapeutic implications. Eur Heart J 25:81\u201387","journal-title":"Eur Heart J"},{"issue":"Suppl 1","key":"880_CR10","first-page":"II324","volume":"108","author":"JM Song","year":"2003","unstructured":"Song JM, Kim HS, Song JK et al (2003) Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. Circulation 108(Suppl 1):II324\u2013II328","journal-title":"Circulation"},{"key":"880_CR11","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1148\/radiology.218.3.r01mr24719","volume":"218","author":"LE Quint","year":"2001","unstructured":"Quint LE, Williams DM, Francis IR et al (2001) Ulcer like lesions of the aorta: imaging features and natural history. Radiology 218:719\u2013723","journal-title":"Radiology"},{"key":"880_CR12","doi-asserted-by":"publisher","first-page":"S91","DOI":"10.1161\/CIRCULATIONAHA.111.084541","volume":"126","author":"KM Harris","year":"2012","unstructured":"Harris KM, Braverman AC, Eagle KA et al (2012) Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation 126:S91\u2013S96","journal-title":"Circulation"},{"key":"880_CR13","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1016\/j.jvs.2013.05.099","volume":"58","author":"JL Tolenaar","year":"2013","unstructured":"Tolenaar JL, Harris KM, Upchurch GR Jr et al (2013) The differences and similarities between intramural hematoma of the descending aorta and acute type B dissection. J Vasc Surg 58:1498\u20131504","journal-title":"J Vasc Surg"},{"key":"880_CR14","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.jtcvs.2012.11.015","volume":"147","author":"M Hata","year":"2014","unstructured":"Hata M, Hata H, Sezai A, Yoshitake I, Wakui S, Shiono M (2014) Optimal treatment strategy for type A acute aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg 147:307\u2013311","journal-title":"J Thorac Cardiovasc Surg"},{"key":"880_CR15","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1093\/icvts\/ivz222","volume":"30","author":"YY Chen","year":"2020","unstructured":"Chen YY, Yen HT, Lo CM, Wu CC, Huang DK, Sheu JJ (2020) Natural courses and long-term results of type A acute aortic intramural haematoma and retrograde thrombosed type A acute aortic dissection: a single-centre experience. Interact Cardiovasc Thorac Surg 30:113\u2013120","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"880_CR16","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1161\/CIRCULATIONAHA.109.907246","volume":"120","author":"A Evangelista","year":"2009","unstructured":"Evangelista A, Eagle KA (2009) Is the optimal management of acute type a aortic intramural hematoma evolving? Circulation 120:2029\u20132032","journal-title":"Circulation"},{"key":"880_CR17","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/1749-8090-4-54","volume":"4","author":"NG Baikoussis","year":"2009","unstructured":"Baikoussis NG, Apostolakis EE, Siminelakis SN, Papadopoulos GS, Goudevenos J (2009) Intramural haematoma of the thoracic aorta: who\u2019s to be alerted the cardiologist or the cardiac surgeon? J Cardiothorac Surg 4:54. https:\/\/doi.org\/10.1186\/1749-8090-4-54","journal-title":"J Cardiothorac Surg"},{"key":"880_CR18","doi-asserted-by":"publisher","first-page":"87","DOI":"10.5582\/irdr.2017.01011","volume":"6","author":"Y Yu","year":"2017","unstructured":"Yu Y, Fei A, Wu Z, Wang H, Pan S (2017) Aortic intramural hemorrhage: a distinct disease entity with mystery. Intractable Rare Dis Res 6:87\u201394","journal-title":"Intractable Rare Dis Res"},{"key":"880_CR19","doi-asserted-by":"publisher","first-page":"20150825","DOI":"10.1259\/bjr.20150825","volume":"89","author":"T Valente","year":"2016","unstructured":"Valente T, Rossi G, Lassandro F et al (2016) MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol 89:20150825","journal-title":"Br J Radiol"},{"key":"880_CR20","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1148\/radiology.204.3.9280256","volume":"204","author":"T Arita","year":"1997","unstructured":"Arita T, Matsunaga N, Takano K et al (1997) Abdominal aortic aneurysm: rupture associated with the high-attenuating crescent sign. Radiology 204:765\u2013768","journal-title":"Radiology"}],"container-title":["Insights into Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13244-020-00880-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13244-020-00880-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13244-020-00880-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,23]],"date-time":"2021-05-23T23:07:18Z","timestamp":1621811238000},"score":1,"resource":{"primary":{"URL":"https:\/\/insightsimaging.springeropen.com\/articles\/10.1186\/s13244-020-00880-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,24]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["880"],"URL":"https:\/\/doi.org\/10.1186\/s13244-020-00880-9","relation":{},"ISSN":["1869-4101"],"issn-type":[{"type":"electronic","value":"1869-4101"}],"subject":[],"published":{"date-parts":[[2020,5,24]]},"assertion":[{"value":"15 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Chang Gung Medical Foundation (approval number: 202000207B0). The need for written informed consent from the patients was waived due to the retrospective and anonymous nature of the analysis.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"73"}}