Imaging is also important for prognostication and to help guide clinical decision making as a number of imaging characteristics have been correlated with increased mortality rates including. Two of these patients showed early aortic ectasia and one showed a pericardial effusion. An axial computed tomography image from a patient with acute chest pain demonstrates crescentic thickening of the medial aortic wall arrows, with displaced intimal calcifications arrowhead. Acute aortic syndrome aas is classically composed of three entities. Radiofrequency catheter ablation of atrial fibrillation carries a risk of thermal damage to extracardiac structures, including the esophagus and the phrenic nerves 1.
Radiologists must be familiar with the imaging appearances of imh as computed tomography ct plays a critical role in both diagnosis and patient management. Background aortic intramural hematoma imh is a variant of overt aortic dissection. Guidelines aortic diseases aortic aneurysm acute aortic syndrome aortic dissection. Sundt, md division of cardiovascular surgery, mayo clinic, rochester, minnesota intramural hematoma and penetrating aortic ulcer are uncommon but potentially lethal thoracic aortic pathologies. Pdf intramural aortic hematoma and anticoagulation. Intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. The patient was treated with strict blood pressure control and thoracic endovascular aortic repair. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. Pdf acute aortic syndromes include a variety of overlapping clinical and anatomic diseases.
Diseases of the aorta american society of echocardiography. Diagnosis and treatment of thoracic aortic intramural hematoma. The wall is higher in attenuation than the adjacent aortic lumen is due to acute hemorrhage. The classic aortic dissection involves an intimomedial flap, which traverses the aortic lumen. Aortic intramural hematoma imh is an atypical form of aortic dissection due to hemorrhage into the wall from the vasa vasorum without an intimal tear. Current understandings and approach to the management of. Pdfdateien in einzelne seiten aufteilen, seiten loschen oder drehen, pdfdateien einfach zusammenfugen oder. Aortic intramural hematoma imh is a condition characterized by blood leaking through the innermost layer of the aortic wall and flowing between the inner and outer walls. Intramural hematoma and penetrating aortic ulcer are nonflap lesions, with intramural hematoma showing no intimal disruption and penetrating aortic ulcer showing an ulcer at the atherosclerotic plaque burrowing through the aortic intima and media. Few cases of imh cases are asymptomatic and are incidentally diagnosed.
The aim of this study was to evaluate outcomes of patients with type b imh after best medical therapy bmt, and assess what variables are associated with failure of bmt. All enrolled patients were followed up for adverse aortarelated events, defined as a composite of aortic diseaserelated death. The dynamic evolution of aortic intramural hematoma jacc. Intramural hematoma and penetrating atherosclerotic ulcer of the aorta thoralf m. Some authors have suggested that imh is the result of spontaneous rupture. Intramural aortic hematoma and anticoagulation request pdf. Intramural hematoma imh is defined as localized hemorrhage within the aortic wall and is included in the acute aortic syndrome spectrum with aortic dissection and penetrating aortic ulcer. Intramural aortic hematoma and anticoagulation revista. Aortic intramural haematoma imh has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome.
Acute intramural hematoma of the descending thoracic aorta. Aortic intramural haematoma imh is a less known entity within the spectrum of. A 64yearold man was admitted for crushing chest pain. Aortic intramural haematoma imh is an atypical form of aortic dissection due to haemorrhage into the wall from the vasa vasorum without an intimal tear. The incidence of acute aortic syndrome ranges from 3. Aortic intramural haematoma radiology reference article. Hematoma intramural aortico y anticoagulacion revista espanola. Intramural hematoma or aortic dissection a diagnostic.
Aortic intramural hematoma after catheter ablation for. Intramural hematoma and penetrating atherosclerotic ulcers. This leakage does not occur due to a tear in the aortic wall and, because of this, the condition has been difficult to diagnose until recently. Aortic dissection, axial views aortic dissection, sagittal views intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. These entities share a common clinical presentation and risk factor profile, including acute chest pain and chronic hypertension 1. We read with interest the excellent study by song et al. Despite being identified almost 100 years ago, there is considerable controversy surrounding the definition, etiology, management, and the very existence of intramural hematoma. The natural history and outcomes for thoracic and abdominal. Aortic intramural haematoma imh, a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome aas. We write to address a limitation of this study and most other available literature on this topicnamely, the brief followup time after presentation. Aortic intramural hematoma imh is related to but is pathologically distinct from aortic dissection. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based. The differences and similarities between intramural.
Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation. Imaging features of intramural hematoma of the aorta. Patients who had identifiable intimal flap, tear, or penetrating aortic ulcer were excluded from the study. It is essential to combine comprehensive imaging diagnostics and their careful interpretation with laboratory examinations and analysis of clinical. Diagnosis and therapeutic consequences of intramural. Intramural haematoma imh is a localised haemorrhage within the aortic wall. Whereas many reports combine aortic dissection, intra mural hematoma, and.
B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. Intramural hematoma and penetrating aortic ulcer are uncommon but. Imh is diagnosed in the presence of circular or crescentic thickening 5 mm of the aortic wall in the absence of detectable. Despite this confusion exists regarding the precise. Intramural hematoma and penetrating atherosclerotic ulcer of the.
Pdf aortic luminal thrombus and intramural hematoma. Purpose to evaluate multidetector computed tomographic ct images to investigate the prevalence, morphology, natural course, and prognostic effect of intramural blood pools ibps in patients with acute intramural hematoma imh. Intramural hematoma and penetrating aortic ulcer are uncommon but potentially lethal thoracic aortic pathologies. The mortality from imh is similar to classic aortic dissection 21%. A 69 year old woman with ho htn, hyperlipidemia and cad. Although intimal disruption is not present, the prognosis is similar to that of classic aortic dissection. Intramural hematoma is the most enigmatic of the 3 lethal entities comprising acute aortic syndrome. An intramural hematoma results from rupture of the vasa vasorum and hemorrhage into the arterial media, which leads to weakening of the aortic wall. Intramural hematoma imh is a lifethreatening aortic disease included within acute aortic syndrome, together with aortic dissection and penetrating aortic ulcer pau. Aortic intramural hematoma and its complications circulation.
Acute aortic dissection and intramural hematoma american. Emerging concepts in intramural hematoma imaging1 intramural hematoma imh is included in the spectrum of acute aortic syndrome and appears as an area of hyperattenuating crescentic thickening in the aortic wall that is best seen at nonenhanced computed tomography. Pdf we report a case of type a intramural aortic hematoma imh occurred in a 78 years old female. We performed a retrospective pooled analysis of individual patient data, including baseline and followup ct characteristics. Among 34 patients presenting with clinical signs and symptoms of an aortic dissection, three did not show the mandatory flap in the upstream aorta. Aortic intramural hematoma type b imhb is a variant of acute aortic syndrome, which presents with symptoms similar to classic type b aortic dissection abad. Importance acute aortic syndrome aas, a potentially fatal pathologic process within the aortic wall, should be suspected in patients presenting with severe thoracic pain and hypertension. This was a retrospective study of all patients who had intramural hematoma at our institution from 1989 to 1994. The natural histories of intramural hematoma imh and penetrating atherosclerotic ulcer pau are highly variable as they may progress to aneurysm formation. Intramural hematoma imh is on the spectrum of acute aortic syndrome but optimal management is poorly understood. The distinguishing feature of this entity is an absence of the intimal disruption that characterizes classic aortic dissection fig 1 2. Aas, including aortic dissection approximately 90% of cases and intramural hematoma, may be complicated by poor perfusion, aneurysm, or uncontrollable pain and hypertension.
Aortic intramural hematoma imh is a pathologic process with a clinical presentation identical to aortic dissection and associated with significant morbidity and mortality. Fiveyear results of a merger between vascular surgeons and interventional radiologists in a university medical center. Hematoma intramural e ulcera penetrante da aorta scielo. The 2010 aha guidelines state that intramural hematomas imhs involving the ascending aorta have a high, early risk. Aortic luminal thrombus and intramural hematoma after. Aortic intramural haematoma imh is a subtype of acute aortic syndrome.
Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic patients to whom there is spontaneous. Imaging findings in aortic intramural hematoma jacc. The adventitial vv are present in the large elastic vessels with more than 29 lamellae, and are thus found in greater numbers in the ascending aorta, the aortic arch, and the descending aorta, and in smaller quantities in the abdominal aorta. We read with interest the article on the successful diagnostic and treatment of this difficult and rare pathology. Aortic intramural hematoma radiology reference article. Intramural hematoma may also develop as a result of blunt chest trauma with aortic wall injury. Imh is distinguished from aortic dissection ad in the point of intimal tear exists or not. Treatment for acute type b intramural hematoma and patent. Aortic intramural hematoma imh is one of several conditions included in the acute aortic syndrome aas. Intramural hematoma and penetrating atherosclerotic ulcer. Intramural hematoma or aortic dissection a diagnostic and. Computed tomography revealed an aortic intramural hematoma, with progression to a penetrating aortic ulcer on day 7 and aortic dissection on day 30. Ct findings of imh is crescentic or circular aortic wall hyperattenuation in noncontrast enhanced ct.
Many aspects of its natural history remain poorly understood, and the best treatment is not known. The only echocardlographic finding was aortic wall thickening indicating an intramural hematoma. Aortic intramural haematoma imh is an entity belonging to the spectrum of acute aortic syndrome aas in which haemorrhage occurs in the media of the aortic wall in the absence of a demonstrable twolumen flow and primary intimal tear. The differences and similarities between intramural hematoma of the descending aorta and acute type b dissection. About 6 20% of aortic dissection are intramural hematoma cases 106553 from pooled data intramural hematoma thickening of aortic wall 0. Whereas many reports combine aortic dissection, intramural hematoma, and paus into the acute aortic syndrome, there are differences in the presentation.
Acute aortic syndrome is an acute, potentially fatal pathology within the wall of the aorta, including aortic dissection, intramural hematoma imh, and penetrating atherosclerotic ulcer. Aortic intramural hematoma imh is a clinical condition that has still not been completely defined. Despite incomplete understanding of their natural history, they have emerged as anatomically appealing targets of endovascular therapy. The reported incidence of acute type a aortic intramural hematoma ataaimh varies between 3.
Aortic intramural hematoma imh is a lifethreatening disease that usually presents with aortic pain and is characterized by sudden chest pain that may radiate to the back or neck 1. Some include a fourth category, the recently described incomplete dissection. Imaging plays a central role in diagnosing imh, differentiating it from aortic dissection ad and assessing for complications. Natural history and ct appearances of aortic intramural. The authors present a case report of a 60yearold patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. Pdf penetrating aortic ulcer and intramural hematoma. Hematoma intramural aortico y anticoagulacion revista.
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