In all patients, the intramural aortic hematoma was observed to undergo gradual regression despite anticoagulation therapy. Imh also frequently leads to aortic emergency, which can be fatal unless rapidly diagnosed and treated. Clinical features and longterm outcome of type a and type b intramural hematoma of the aorta. Thus, applying this characteristic finding to the diagnosis of imh should be limited to patients with acute aortic syndrome. Endovascular repair of aortic dissection and intramural. Intramural hematoma appearing as a new lesion after. Pdf aortic luminal thrombus and intramural hematoma. This is the first case of right atrial intramural hematoma associated with aortic dissection exhibiting high mortality. We described a 6 years followup of a spontaneous aortic intramural hematoma imh with cardiovascular magnetic resonance cmr. Atypical presentation of intramural hematoma of the ascending aorta using a conservative approach claudia maria rodrigues alves1,2, manuel pereira marques gomes jr. Treatment patterns and their outcomes of acute aortic.
In 17 patients with new development of ulcerlike projection, 12 70% of 17 projections progressed to complications such as enlargement n 10 or. Other risk factors include hemophilia, idiopathic thrombocytopenic purpura, leukemia, lymphoma, myeloma, chemotherapy, vasculitis, pancreatitis, and pancreatic cancer 17. Aortic intramural hematoma radiology reference article. Aortic intramural hematoma imh is an important component of acute aortic syndrome.
The presentation of patients who have spontaneous intramural smallbowel hematoma can vary from mild and vague ab. Hematoma intramural aortico y anticoagulacion revista. An 85 year old lady presented to us with acute abdomen. Hematoma intramural aortico y anticoagulacion revista espanola. Birchard clinical history 69yearold female with chest pain. Aortic intramural hematoma imh is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. She was on warfarin and was found to have grossly deranged clotting parameters. Overanticoagulation by warfarin is the most common cause of spontaneous intramural smallbowel hematoma.
Hematoma intramural aortico y anticoagulacion 19 co breve 7691201204 19207 14. Intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Unlike aortic dissection, no intimal flap is present. Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation. Intramural aortic hematoma and anticoagulation request pdf. Intramural hematoma and penetrating atherosclerotic ulcer. 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. Computed tomographic coronal reformatted contrastenhanced image showing an ascending aortic intramural hematoma arrows extending from the sinuses of valsalva to the origin of the brachiocephalic artery. On physical examination, her pulse rate was 68 bpm and blood pressure was 10061 mm hg, equal in both arms. Iatrogenic aortic dissection or intramural hematoma. Initial optimal management of acute type a aortic dissection ataad with intramural hematoma ataimh remains controversial, especially between centers in the eastern vs. Using the ed ultrasound there was a small amount of pericardial fluid seen.
Some authors have suggested that imh is the result of spontaneous rupture. 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. 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. 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. The most commonly cited explanation for imh is rupture of vasa vasora with intramural hemorrhage, although data to support this contention are thin. Ri slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Many aspects of its natural history remain poorly understood, and the best treatment is not known. Aortic intramural hematoma imh is one of several conditions included in the acute aortic syndrome aas. A mystery in evolution, abstract background the definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma imh continue to be debated. Axial noncontrast ct image shows nearcircumferential high attenuation soft tissue blue arrows in the wall of a dilated ascending aorta. Natural history and serial morphology of aortic intramural hematoma. Intramural hematoma imh of the aorta is recognized as distinct from classic doublebarreled ad. Aortic intramural hematoma imh is an acute aortic syndrome with symptoms similar to those of aortic dissection. Pdf intramural blood pools accompanying aortic intramural.
Publications before 1997 are incorporated using results from our previous analysis 1. 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. Penetrating aortic ulcer pau, intramural hematoma imh. Longterm prognosis of patients with type b aortic intramural hematoma. 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. Many aspects of its natural history remain poorly understood, and the. Images in clinical medicine from the new england journal of medicine 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. New development of an ulcerlike projection in aortic. The aim of this study is to evaluate clinical outcomes of patients with acute aortic imh from real world registry data. Pdf penetrating aortic ulcer and intramural hematoma.
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. Radiologic and intraoperative finding of intimal tear in type a. Intramural aortic hematoma and anticoagulation revista espanola. A misdiagnosis may lead to an unnecessary and even hazardous surgical intervention. A mobile chest xray was obtained as part of the initial resuscitation. 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.
Intramural hematoma demographics usually in older patients except genetic syndromes majority of patients have hypertension many patients have atherosclerosis with or without aneurysm presentation. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. 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. Intramural blood pools accompanying aortic intramural hematoma. Findings in spontaneous intramural intestinal hematoma. Intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Evaluation by ct can identify imaging features associated with higher risk 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. Natural history of spontaneous aortic intramural hematoma. Some authors have suggested that imh is the result of.
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. Frontal a widened mediastinum was noted, although an ap projection it was wide enough to evoke suspicion of an aortic dissection. 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. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. Intramural hematoma of the aorta imh, a variant of classic aortic dissection, shows very dynamic process in the early phase. Intramural hematoma calgary thoracic aorta program. Thoracic aortic dissection ad is one of the most common aortic emergencies. Intramural aortic hematoma and anticoagulation revista. We examined the literature and our experience to report outcomes after repair of ataimh. Right atrial intramural hematoma associated with aortic. 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.
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. Aortic intramural hematoma imh is described as dissection without intimal tear due to rhexis. 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. Spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy. The patient sustained cardiorespiratory arrest and died. Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic.
Intramural hematomas can occur at both the distal 55% and proximal stent edges 45%. Aortic intramural hematoma is a severe disease, secondary to vasa vasorum bleeding andor aortic microulcers without connection with thetrue lumen of the vessel. Imh weakens the aortic wall and may progress to either outward rupture. 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. Intramural hematomas imh are regarded as a hemorrhage into the aortic wall. 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 blood pools accompanying aortic intramural. 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. 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. Advances in imaging techniques have facilitated diagnosis and have aided understanding of the natural history of this entity, practically unknown 10 years ago. Assessment of clinical and radiological features in comparison to acute aortic dissection1 kwonha yoon, m.
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