Ascending Aortic Dissection without Intimal Tear: A Case Report

Abstract

Aortic dissection may occur without the presence of intimal tear, and it may occur with medial dissection and intramural hematoma. We report a case in which mediastinal enlargement was found in the chest x-ray of a 79-year-old patient with chest and back pain that had started suddenly 1 week before. The patient had a decrease in hematocrit, and transthoracic echocardiography revealed around the heart pericardial fluid 5 cm thick. The ascending aorta could not be evaluated because of the presence of this fluid. The preoperative diagno-sis, based on the computerized tomography findings (dissec-tion of ascending aorta and pericardial fluid), was ruptured dissection of the ascending aorta. The patient underwent an emergency operation. Two liters of hemorrhagic fluid was aspi-rated from the pericardium during the operation. The ascend-ing aorta was opened, but there was no intimal tear. Medial dissection and intramural hemorrhage were seen. The ascend-ing aorta was replaced with a tube graft. Cases such as this, of medial dissection and intramural hematoma in which intimal integrity is preserved, should be approached in the same man-ner as classical dissections with intimal tear.