This case highlights the importance of high clinical suspicion and CT angiography in diagnosing aortic intramural hematoma in elderly patients presenting with chest pain.
Alerts clinicians to aortic intramural hematoma in elderly patients; leaves open optimal management from single-case observations.
Aortic intramural hematoma is a significant presentation of aortic syndromes. It is characterized by bleeding within the aortic media without an intimal defect and can lead to acute aortic dissection if the intimal layer ruptures. Diagnosis requires a high level of suspicion, with CT angiography being essential for confirmation, especially to differentiate it from other conditions. In this case report, we discuss the presentation of an 84-year-old African American female with hypothyroidism and hypertension who presented with chest pain, nausea, and hypertension. Lab tests showed mild lactic acidosis and elevated troponins, with a positive drug screen for amphetamines, and she was diagnosed with acute intramural hematoma as well as pericardial effusion on imaging. Aortic intramural hematoma affects elderly individuals with risk factors for severe atherosclerotic disease. Diagnosis involves imaging studies, particularly noncontrast CT scans, followed by contrast CT scans. The prognosis varies based on the type of intramural hematoma. Further research is needed to guide conservative treatment strategies.
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Javed et al. (2025) studied this question.
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