This case highlights that extensive intramural hematoma can progress to acute type A aortic dissection, necessitating close monitoring and potential surgical intervention.
Alerts clinicians to possible rapid progression in intramural hematoma; leaves open optimal surveillance frequency and intervention thresholds.
A seventy-three-year-old woman had symptoms of aortic dissection. Initial computed tomographic (CT) scan and angiography showed an extensive intramural hematoma (IMH) of the aortic segment from the ascending aorta to the bulk of the descending aorta without intimal tear or false lumen. Two weeks later the patient's symptoms recurred. A repeat CT demonstrated a classic type A aortic dissection with a false lumen and an intimal defect. The patient underwent a successful hemiarch repair with use of selective cerebral perfusion under profound hypothermic circulatory arrest. This case suggests extensive IMH as an important underlying pathology of the aortic dissection.
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Moriyama et al. (1997) studied this question.
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