DIAGNOSTIC TRICKS AND TIMELY TREATMENT OF AORTIC INTRAMURAL HEMATOMA
Hanumanth K. Reddy, M.D., St. Louis University Medical School, St. Louis, MO, USA
Aortic intramural hematoma is a variant of acute aortic syndrome with a presentation similar to that of acute aortic dissection but difficult to make a timely diagnosis. This entity may be easily missed because of the absence of the intimal flap often seen in classical dissection. An intramural hematoma is formed from medial hemorrage from rupture of the vasa vasorum and the subsequent weakening of the aortic wall. Inspite of the subtlety of this condition, it is critical to make a prompt diagnosis because of the high mortality rate of 21% associated with it. Some specific CT findings on the unenhanced and contrast-enhanced CT axial images are listed below 1. Intimal areas of calcification in a curvilinear configuration.2. An enlarged aortic diameter and crescentic, eccentric hyperattenuating area of the thickened aortic wall (60-70 HU) Conventional aortic angiogram may not detect intramural hematoma since the appearance of intimal flap and double lumen is absent. CT and TEE show circumferential or crescentic aortic wall thickening of more than 7mm.Therefore, prompt and accurate detection of aortic intramural hematomas is critical to providing appropriate therapy. Timely surgical repair of ascending aortic intramural hematoma is needed whereas medical therapy with a good control of blood pressure may be pursued in patients with descending aortic intramural hematoma.