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DOI: 10.1055/s-0040-1714058
Large Intramural Aortic Hematoma with Intimal Tear
Funding None.![](https://www.thieme-connect.de/media/10.1055-s-00039245/202004/lookinside/thumbnails/10-1055-s-0040-1714058_180057-1.jpg)
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.
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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References
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- 2 Sundt TM. Intramural hematoma and penetrating atherosclerotic ulcer of the aorta. Ann Thorac Surg 2007; 83 (02) S835 –S841, discussion S846–S850