Type A Intramural Hematoma Often Turns Out To Be a Type A Dissection
Background: The management of type A intramural hematoma (IMH) is controversial. Although most Western countries still recommend immediate surgical repair, some centers in Asia have shown good results recently with medical treatment alone. Here, we present a case of type A IMH which was discovered during the operation to be a thrombosed type A dissection.
Case Report: An 83-year-old female patient presented with acute chest pain. After diagnostic exclusion of myocardial infarction, computed tomography was performed, which showed an IMH from the ascending to the descending aorta. No intimal flap could be detected. The ascending aorta was replaced surgically with a prosthesis. During the operation, we found a ruptured intimal plaque, which had caused dissection of the aorta with thrombosis of the false lumen. The true diagnosis—thrombosed type A dissection and not IMH—was revealed neither by computed tomography nor by transesophageal echocardiography.
Conclusion: Type A IMH should still be treated with immediate surgical repair because in many cases it turns out to be thrombosed type A dissection.
Evangelista A, Mukherjee D, Mehta RH, et al. 2005. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 111:1063-70.nHoey ETD, Wai D, Ganeshan A, Watkin RW. 2012. Aortic intramural haematoma: pathogenesis, clinical features and imaging evaluation. Post-grad Med J 88:661-7.nKitai 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:S292-8.nNienaber CA, Powell JT. 2012. Management of acute aortic syndromes. Eur Heart J 33:26-35.nUchida K, Imoto K, Karube N, et al. 2013. Intramural haematoma should be referred to as thrombosed-type aortic dissection. Eur J Cardiothorac Surg 44:366-9.n
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