80-year-old patient:
* Underwent aortic arch repair two years ago, now experiencing back pain
* Elevated levels of troponinin I (TNI) and D dimers
* Small pericardial effusion
What is the diagnosis?
Intramural hematoma type A.
Explanation:
Aortic intramural hematoma (IMH) is an atypical form of aortic dissection. It is considered part of the acute aortic syndrome spectrum, which also includes penetrating atherosclerotic ulcers and classical aortic dissection. The condition involves a contained hemorrhage within the aortic wall, which is best visualized on non-contrast CT scans. On contrast-enhanced imaging, a small ulcer-like projection (ULP) is observed, with an ascending aorta diameter of 53 mm. Risk factors for progression of intramural hematoma and worse prognosis include the presence of ULPs, IMH thickness greater than 10 mm, associated aortic aneurysm, and increase of the thickness of the intramural hematoma at follow-up CTA. Similar to aortic dissections, aortic intramural hematomas are categorized according to the Stanford classification system (type A: involves the ascending aorta, with or without descending aortic involvement, type B: confined to the descending aorta, distal to the origin of the left subclavian artery).The patient underwent emergency supracoronary ascending aortic replacement.
İntramural hematoma of aorta
ascending aorta intramural hematoma