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CC BY 4.0 · Aorta (Stamford) 2020; 08(04): 118-120
DOI: 10.1055/s-0040-1714058
Images in Aortic Disease

Large Intramural Aortic Hematoma with Intimal Tear

Frédéric Jacques 
1   Departments of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec–IUCPQ, Quebec, QC, Canada
,
Michel Gingras
2   Departments of Medical Imaging, Institut Universitaire de Cardiologie et de Pneumologie de Québec–IUCPQ, Quebec, QC, Canada
,
Valérie Lafrenière-Bessi 
1   Departments of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec–IUCPQ, Quebec, QC, Canada
,
Jean Perron
1   Departments of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec–IUCPQ, Quebec, QC, Canada
,
François Dagenais
1   Departments of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec–IUCPQ, Quebec, QC, Canada
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Abstract

A 72-year-old man presented with excruciating epigastric pain. A chest computed tomography angiography revealed an aortic intramural hematoma. A filling defect within the distal ascending aorta was noted. Images of an intramular hematoma and surgical details of an ascending aortic replacement under deep hypothermic circulatory arrest are provided.

Keywords

aortic intramural hematoma - dissection - acute aortic syndrome

Editor’s Comments

Surgeons who operate on intramural hematoma (IMH) cases have long noted that intimal tears are often found at surgery, despite their not being seen on radiographic imaging. This is important because it contradicts the conventional wisdom that IMHs represent rupture of vasa vasorum without connection to the lumenal blood flow. The case reported and illustrated by Jacques and colleagues supports an alternate understanding of etiology and pathophysiology of IMH. That is to say, although IMHs do not demonstrate the intimal flap of typical aortic dissection, they may indeed originate via a tear in the intima of the aorta. (Another possibility is that the IMH originates via rupture of a vasa vasorum and subsequently ruptures through the aortic intimal.)




Publication History

Received: 15 November 2018

Accepted: 24 May 2020

Article published online:
09 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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