Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.

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Surgical intervention is superior to medical therapy in the management of type A aortic intramural hematoma

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)81676-5 ◽

2003 ◽

Vol 41 (6) ◽

pp. 235 ◽

Cited By ~ 1

Author(s):

Kevin J. Mikielski ◽

Andrew Thomas McRae ◽

Marc S. Penn ◽

Monvadi B. Srichai ◽

Richard D. White ◽

...

Keyword(s):

Medical Therapy ◽

Surgical Intervention ◽

Intramural Hematoma ◽

Type A ◽

Aortic Intramural Hematoma

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Acute type A aortic intramural hematoma and type A aortic dissection: correlation between the intimal tear features and pathogenesis

Quantitative Imaging in Medicine and Surgery ◽

10.21037/qims-20-191 ◽

2020 ◽

Vol 10 (7) ◽

pp. 1504-1514

Author(s):

Yu Li ◽

Nan Zhang ◽

Shangdong Xu ◽

Zhanming Fan ◽

Junming Zhu ◽

...

Keyword(s):

Aortic Dissection ◽

Intramural Hematoma ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Intramural Hematoma ◽

Intimal Tear

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Prediction of Progression or Regression of Type A Aortic Intramural Hematoma by Computed Tomography

Circulation ◽

10.1161/circ.100.suppl_2.ii-281 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Shuichiro Kaji ◽

Kazuhiro Nishigami ◽

Takashi Akasaka ◽

Takeshi Hozumi ◽

Tsutomu Takagi ◽

...

Keyword(s):

Computed Tomography ◽

Wall Thickness ◽

Aortic Wall ◽

Intramural Hematoma ◽

Type A ◽

Ct Images ◽

Aortic Diameter ◽

Aortic Wall Thickness ◽

Aortic Intramural Hematoma

Background —It has been reported that early surgery should be required for patients with type A aortic intramural hematoma (IMH) because it tends to develop classic aortic dissection or rupture. However, the anatomic features of type A IMH that develops dissection or rupture are unknown. The purpose of this study was to investigate the predictors of progression or regression of type A IMH by computed tomography (CT). Methods and Results —Twenty-two consecutive patients with type A IMH were studied by serial CT images. Aortic diameter and aortic wall thickness of the ascending aorta were estimated in CT images at 3 levels on admission and at follow-up (mean 37 days). We defined patients who showed increased maximum aortic wall thickness in the follow-up CT (n=9) or died of rupture (n=1) as the progression group (n=10). The other 12 patients, who all showed decreased maximum wall thickness, were categorized as the regression group. In the progression group, the maximum aortic diameter in the initial CT was significantly greater than that in the regression group (55±6 vs 47±3 mm, P =0.001). A Cox regression analysis revealed that the maximum aortic diameter was the strongest predictor for progression of type A IMH. We considered the optimal cutoff value to be 50 mm for the maximum aortic diameter to predict progression (positive predictive value 83%, negative predictive value 100%). Conclusions —Maximum aortic diameter estimated by the initial CT images is predictive for progression of type A IMH.

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Complicated Intramural Hematoma with Medionecrosis of the Aortic Wall

Aorta ◽

10.1055/s-0041-1729849 ◽

2021 ◽

Author(s):

Rosmi P. Thomas ◽

Natalie Gaughan ◽

Daniel Anderson ◽

Stefano Schena

Keyword(s):

Aortic Wall ◽

Surgical Intervention ◽

Intramural Hematoma ◽

Pathological Findings ◽

Medial Degeneration

AbstractMedionecrosis and medial degeneration are rare complications associated with intramural hematomas (IMHs). We present a case of a 69-year-old Asian female with an IMH with medionecrosis and medial degeneration of the aortic wall. The patient underwent successful surgical intervention, and pathological findings were significant for cystic medial degeneration of the aortic wall.

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