Aortic intramural hematoma imh is an atypical form of aortic dissection due to hemorrhage into the wall from the vasa vasorum without an intimal tear. Treatment patterns and their outcomes of acute aortic. New development of an ulcerlike projection in aortic. Aortic intramural hematoma imh is described as dissection without intimal tear due to rhexis. Initial optimal management of acute type a aortic dissection ataad with intramural hematoma ataimh remains controversial, especially between centers in the eastern vs. Assessment of clinical and radiological features in comparison to acute aortic dissection1 kwonha yoon, m. Spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy. Natural history of spontaneous aortic intramural hematoma. Hematoma intramural aortico y anticoagulacion 19 co breve 7691201204 19207 14.
Atypical presentation of intramural hematoma of the. From observation to therapeutic strategies susanne mohrkahaly, md mainz, germany noninvasive diagnostic imaging procedures, such as magnetic resonance imaging mri, computed tomography ct and transesophageal echocardiography tee 15, have allowed the detection of aortic abnormalities with an. Hematoma intramural aortico y anticoagulacion request pdf. It is not a common diagnosis but is a potentially lethal disorder and imh is sometimes considered as a lead up to classic aortic dissection, rupture or aneurysm. Intramural hematoma imh of the aorta is a pathological pattern whose description has become more and more frequent due to the improvement of diagnostic techniques and in which the most appropriate treatment is still debated 1,2 to our knowledge less than 200 cases, mostly involving the descending aorta, are described in the literature.
We described a 6 years followup of a spontaneous aortic intramural hematoma imh with cardiovascular magnetic resonance cmr. Some authors have suggested that imh is the result of. Birchard clinical history 69yearold female with chest pain. Figures 2 intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Frontal a widened mediastinum was noted, although an ap projection it was wide enough to evoke suspicion of an aortic dissection. Aortic intramural haematoma imh has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome with acute mortality and rapid progression. Many aspects of its natural history remain poorly understood, and the best treatment is not known. Imh weakens the aortic wall and may progress to either outward rupture. The presentation of patients who have spontaneous intramural smallbowel hematoma can vary from mild and vague ab. Hematoma intramural aortico y anticoagulacion revista espanola. On physical examination, her pulse rate was 68 bpm and blood pressure was 10061 mm hg, equal in both arms.
The aim of this study is to evaluate clinical outcomes of patients with acute aortic imh from real world registry data. Intramural blood pools accompanying aortic intramural. The patient sustained cardiorespiratory arrest and died. Intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Though imh was first described in 1920 as dissection without intimal tear, it was rarely recognized in the clinical setting before the advent of highresolution. Aortic intramural hematoma is among the spectrum of pathologies that comprises acute aortic syndrome and carries a risk of progression to aortic dissection, aneurysm, rupture, and other complications. Nontraumatic spontaneous intramural smallbowel hematoma, once considered a rare complication of oral anticoagulation therapy, is being reported with increasing frequency 1,2,3,4,5,6,7,8,9,10,11,12. We examined the literature and our experience to report outcomes after repair of ataimh. Intramural hematoma and penetrating atherosclerotic ulcer.
Intramural aortic hematoma and anticoagulation revista espanola. In all patients, the intramural aortic hematoma was observed to undergo gradual regression despite anticoagulation therapy. Patients with type a intramural hematoma had a significantly higher frequency of new development of ulcerlike projection than that of patients with type b intramural hematoma p. Intramural hematoma calgary thoracic aorta program. Some authors have suggested that imh is the result of spontaneous rupture. Aortic intramural hematoma radiology reference article. Atypical presentation of intramural hematoma of the ascending aorta using a conservative approach claudia maria rodrigues alves1,2, manuel pereira marques gomes jr.
Intramural aortic hematoma and anticoagulation revista. Ri slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Pdf aortic luminal thrombus and intramural hematoma. Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. An 85 year old lady presented to us with acute abdomen. Intramural hematoma is generally held to account for between 5% and 20% of patients admitted to hospital with the diagnosis of acute aortic syndrome or acute dissection 1518. Aortic intramural hematoma discussion pertinent snippets consequently, intramural hematoma weakens the aorta and may progress either to outward rupture of the aortic wall or to inward disruption of the intima, the latter leading to communicating aortic dissection. Radiologic and intraoperative finding of intimal tear in type a. Right atrial intramural hematoma associated with aortic. Recent advances in imaging techniques have significantly improved the diagnosis and heightened the clinical understanding of imh, which accounts for a frequency of 10% to 30% of all acute aortic syndromes.
Aortic intramural hematoma has been considered a precursor of overt aortic dissection 1, 2. Aortic intramural hematoma imh is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. Intramural blood pools accompanying aortic intramural hematoma. This is the first case of right atrial intramural hematoma associated with aortic dissection exhibiting high mortality. Pdf intramural blood pools accompanying aortic intramural. Clinical features and longterm outcome of type a and type b intramural hematoma of the aorta. Evaluation by ct can identify imaging features associated with higher risk of. Advances in imaging techniques have facilitated diagnosis and have aided understanding of the natural history of this entity, practically unknown 10 years ago. The most commonly cited explanation for imh is rupture of vasa vasora with intramural hemorrhage, although data to support this contention are thin. Natural history and serial morphology of aortic intramural hematoma.
Aortic intramural hematoma imh is a condition characterized by blood leaking through the innermost layer of the aortic wall and flowing between the inner and outer walls. Intramural hematoma imh of the aorta is recognized as distinct from classic doublebarreled ad. Axial noncontrast ct image shows nearcircumferential high attenuation soft tissue blue arrows in the wall of a dilated ascending aorta. Aortic intramural hematoma imh is an important component of acute aortic syndrome. Intramural hematoma appearing as a new lesion after. Pdf penetrating aortic ulcer and intramural hematoma. A mobile chest xray was obtained as part of the initial resuscitation.
The english literature from 1996 to 2001 was screened for reports on outcome of imh using medline key words aortic diseases, aorta, hematoma, and intramural hematoma and crossreferences. Endovascular repair of aortic dissection and intramural. Penetrating aortic ulcer pau, intramural hematoma imh. Aortic intramural hematoma is a severe disease, secondary to vasa vasorum bleeding andor aortic microulcers without connection with thetrue lumen of the vessel. Intramural hematomas can occur at both the distal 55% and proximal stent edges 45%. Unlike aortic dissection, no intimal flap is present. Longterm prognosis of patients with type b aortic intramural hematoma. The angiographic appearance of an intramural hematoma is generally a dissection 60% of cases, but in 11% it appears as spasm or a new lesion, and in 29% there is no significant angiographic abnormality. She was on warfarin and was found to have grossly deranged clotting parameters. Aortic intramural hematoma imh is an acute aortic syndrome with symptoms similar to those of aortic dissection.
Images in clinical medicine from the new england journal of medicine aortic intramural hematoma. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. Aortic intramural hematoma imh is an acute aortic syndrome characterized by bleeding into the media of the aortic wall without intimal disruption or the classic flap formation. Overanticoagulation by warfarin is the most common cause of spontaneous intramural smallbowel hematoma. Using the ed ultrasound there was a small amount of pericardial fluid seen. We analyzed 165 consecutive patients with acute imh from five medical centers in korea.
Evangelista a, mukherjee d, mehta rh, ogara pt, fattori r, cooper jv, et al. Iatrogenic aortic dissection or intramural hematoma. Many aspects of its natural history remain poorly understood, and the. Thus, applying this characteristic finding to the diagnosis of imh should be limited to patients with acute aortic syndrome. Intramural hematoma of the aorta imh, a variant of classic aortic dissection, shows very dynamic process in the early phase.
This leakage does not occur due to a tear in the aortic wall and, because of this, the condition has been difficult to diagnose until recently. A misdiagnosis may lead to an unnecessary and even hazardous surgical intervention. Thoracic aortic dissection ad is one of the most common aortic emergencies. Outcomes and management of type a intramural hematoma. Intramural aortic hematoma and anticoagulation request pdf. A mystery in evolution, abstract background the definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma imh continue to be debated. Aortic intramural haematoma imh, a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome aas. It can be fatal if not promptly diagnosed and treated.
Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic. Publications before 1997 are incorporated using results from our previous analysis 1. Intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. In 17 patients with new development of ulcerlike projection, 12 70% of 17 projections progressed to complications such as enlargement n 10 or. Intramural hematoma demographics usually in older patients except genetic syndromes majority of patients have hypertension many patients have atherosclerosis with or without aneurysm presentation.
Intramural hematomas imh are regarded as a hemorrhage into the aortic wall. Aortic intramural hematoma imh is one of several conditions included in the acute aortic syndrome aas. Imh also frequently leads to aortic emergency, which can be fatal unless rapidly diagnosed and treated. Hematoma intramural aortico y anticoagulacion revista. Findings in spontaneous intramural intestinal hematoma.
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