The aim of this study is to evaluate clinical outcomes of patients with acute aortic imh from real world registry data. Aortic intramural hematoma has been considered a precursor of overt aortic dissection 1, 2. Findings in spontaneous intramural intestinal hematoma. 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. Outcomes and management of type a intramural hematoma. Imh also frequently leads to aortic emergency, which can be fatal unless rapidly diagnosed and treated. Iatrogenic aortic dissection or intramural hematoma.
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. 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. Penetrating aortic ulcer pau, intramural hematoma imh. We described a 6 years followup of a spontaneous aortic intramural hematoma imh with cardiovascular magnetic resonance cmr. Aortic intramural hematoma is a severe disease, secondary to vasa vasorum bleeding andor aortic microulcers without connection with thetrue lumen of the vessel. Other risk factors include hemophilia, idiopathic thrombocytopenic purpura, leukemia, lymphoma, myeloma, chemotherapy, vasculitis, pancreatitis, and pancreatic cancer 17. Atypical presentation of intramural hematoma of the ascending aorta using a conservative approach claudia maria rodrigues alves1,2, manuel pereira marques gomes jr. A mobile chest xray was obtained as part of the initial resuscitation. 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. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. Spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy. Birchard clinical history 69yearold female with chest pain.
Intramural aortic hematoma and anticoagulation revista. Images in clinical medicine from the new england journal of medicine aortic intramural hematoma. A misdiagnosis may lead to an unnecessary and even hazardous surgical intervention. A crescentshaped area along the aorta wall with higher attenuation than that of blood on the noncontrast ct scan no contrast enhancement effect within the area on the postcontrast ct scan smooth lumenwall interface 2.
Intramural aortic hematoma and anticoagulation revista espanola. Aortic intramural hematoma imh is one of several conditions included in the acute aortic syndrome aas. Evaluation by ct can identify imaging features associated with higher risk of. On physical examination, her pulse rate was 68 bpm and blood pressure was 10061 mm hg, equal in both arms. Figures 2 intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Hematoma intramural aortico y anticoagulacion revista. 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. 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.
Atypical presentation of intramural hematoma of the. Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic. 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. 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. 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 aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Many aspects of its natural history remain poorly understood, and the best treatment is not known. Intramural blood pools accompanying aortic intramural hematoma.
Intramural blood pools accompanying aortic intramural. Many aspects of its natural history remain poorly understood, and the. Natural history of spontaneous aortic intramural hematoma. The presentation of patients who have spontaneous intramural smallbowel hematoma can vary from mild and vague ab. 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. Intramural hematomas imh are regarded as a hemorrhage into the aortic wall. It can be fatal if not promptly diagnosed and treated. Axial noncontrast ct image shows nearcircumferential high attenuation soft tissue blue arrows in the wall of a dilated ascending aorta. We analyzed 165 consecutive patients with acute imh from five medical centers in korea. Frontal a widened mediastinum was noted, although an ap projection it was wide enough to evoke suspicion of an aortic dissection. Some authors have suggested that imh is the result of spontaneous rupture.
In 17 patients with new development of ulcerlike projection, 12 70% of 17 projections progressed to complications such as enlargement n 10 or. Publications before 1997 are incorporated using results from our previous analysis 1. Assessment of clinical and radiological features in comparison to acute aortic dissection1 kwonha yoon, m. Pdf intramural blood pools accompanying aortic intramural. 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. Thoracic aortic dissection ad is one of the most common aortic emergencies. Advances in imaging techniques have facilitated diagnosis and have aided understanding of the natural history of this entity, practically unknown 10 years ago. She was on warfarin and was found to have grossly deranged clotting parameters. We examined the literature and our experience to report outcomes after repair of ataimh. Thus, applying this characteristic finding to the diagnosis of imh should be limited to patients with acute aortic syndrome. Some authors have suggested that imh is the result of. 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. Intramural hematoma of the aorta imh, a variant of classic aortic dissection, shows very dynamic process in the early phase. Pdf aortic luminal thrombus and intramural hematoma.
Hematoma intramural aortico y anticoagulacion 19 co breve 7691201204 19207 14. Longterm prognosis of patients with type b aortic intramural hematoma. 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. Ri slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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.
Treatment patterns and their outcomes of acute aortic. 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. An 85 year old lady presented to us with acute abdomen. Intramural hematoma and penetrating atherosclerotic ulcer. Initial optimal management of acute type a aortic dissection ataad with intramural hematoma ataimh remains controversial, especially between centers in the eastern vs. 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. Imh weakens the aortic wall and may progress to either outward rupture. The patient sustained cardiorespiratory arrest and died. 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. Hematoma intramural aortico y anticoagulacion revista espanola. Aortic intramural hematoma imh is an acute aortic syndrome with symptoms similar to those of aortic dissection.
In all patients, the intramural aortic hematoma was observed to undergo gradual regression despite anticoagulation therapy. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. Clinical features and longterm outcome of type a and type b intramural hematoma of the aorta. Intramural hematoma appearing as a new lesion after. Right atrial intramural hematoma associated with aortic. Intramural hematoma demographics usually in older patients except genetic syndromes majority of patients have hypertension many patients have atherosclerosis with or without aneurysm presentation. Aortic intramural hematoma radiology reference article. Endovascular repair of aortic dissection and intramural. Unlike aortic dissection, no intimal flap is present.
Natural history and serial morphology of aortic intramural hematoma. The most commonly cited explanation for imh is rupture of vasa vasora with intramural hemorrhage, although data to support this contention are thin. 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 hematoma imh is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation.
Aortic intramural hematoma imh is an important component of acute aortic syndrome. Intramural aortic hematoma and anticoagulation request pdf. Pdf penetrating aortic ulcer and intramural hematoma. Radiologic and intraoperative finding of intimal tear in type a. Aortic intramural hematoma imh is described as dissection without intimal tear due to rhexis. Hematoma intramural aortico y anticoagulacion request pdf. 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. Using the ed ultrasound there was a small amount of pericardial fluid seen. Evangelista a, mukherjee d, mehta rh, ogara pt, fattori r, cooper jv, et al. Intramural hematoma calgary thoracic aorta program. Intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Overanticoagulation by warfarin is the most common cause of spontaneous intramural smallbowel hematoma. New development of an ulcerlike projection in aortic. Intramural hematoma imh of the aorta is recognized as distinct from classic doublebarreled ad.
696 101 501 965 495 1417 416 652 1360 771 303 1183 106 67 1469 65 155 56 1159 652 115 116 1275 412 1298 1537 975 204 1356 975 367 135 102 1199 893 1312 134 1072