Case 8
History:
45 year old male with acute chest pain
Findings:
Enhanced CT of the chest showing thickening of the wall of ascending aorta with small contrast extension from the lumen into the wall indicative of intimal tear.
Diagnosis:
Aortic intramural hematoma (IMH)
Discussion:
Aortic intramural hematoma (IMH) is related but is pathologically a different entity from aortic dissection, characterized by hemorrhage into the aortic media without an intimal tear. Although intimal disruption is not present, the prognosis is similar to that of classic aortic dissection and both are potentially lethal.
IMH is difficult to distinguish from classic dissection on purely clinical grounds. IMH has a variable clinical course. While some patients have limited hemorrhage and respond well to medical therapy, IMH may progress to classic dissection.
Lacking data from clinical trials, treatment of IMH has been mostly empiric. Most authorities currently recommend treatment of IMH similar to that of classic aortic dissection.
References:
- Neilander S. Sawhney, Anthony N. DeMaria, Daniel G. Blanchard, Aortic Intramural Hematoma An Increasingly Recognized and Potentially Fatal Entity. 10.1378/chest.120.4.1340 CHEST October 2001 vol. 120 no. 4 1340-1346
