Key result
Acute aortic dissection with intramural hematoma transitioned to a classic dissection or aneurysm in 40.7% of cases (11 of 27) during follow-up, often requiring surgical intervention.
Observational (n=27)
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Acute aortic dissection with intramural hematoma carries a high risk (40.7%) of progression to classic dissection or aneurysm, challenging the belief that it has a benign prognosis and highlighting the need for close CT surveillance or surgery, especially when the ascending aorta is >5 cm.
Acute aortic dissection with intramural hematoma has been believed to have a good prognosis, but we have encountered the transition of this entity to a classic dissection or aneurysm. We report the serial computed tomography (CT) features in 27 cases of acute aortic dissection with intramural hematoma. Eleven patients (40.7%) developed a classic dissection or aneurysm during follow-up. Four patients (14.8%) showed transition to a classic dissection without resolution of the intramural hematoma; each had a dilated ascending aorta measuring > 5 cm in diameter on the initial CT. One case (3.7%) developed an enlarging aneurysm without resolution of the intramural hematoma. In 19 cases (70.4%), the hematoma resolved; among these 19, the aortic diameter was significantly larger (p < 0.01) than those in a normal control group. Two of these 19 later developed an aneurysm, and four developed a classic dissection. This entity often (40.7%; 11 of 27) required surgical intervention or periodic follow-up CT examinations, particularly with a dilated ascending aorta of > 5 cm in diameter.
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Ide et al. (1996) conducted an observational in Acute aortic dissection with intramural hematoma (n=27). Acute aortic dissection with intramural hematoma vs. Normal control group was evaluated on Development of a classic dissection or aneurysm. Acute aortic dissection with intramural hematoma transitioned to a classic dissection or aneurysm in 40.7% of cases (11 of 27) during follow-up, often requiring surgical intervention.
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