Aug 19, 2014 aortic intramural hematoma imh is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic patients to whom there is spontaneous. Pdf aortic luminal thrombus and intramural hematoma. Hematoma intramural aortico y anticoagulacion revista espanola. Intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Improved imaging techniques have led to better definition of the range of diseases that can affect the thoracic aorta. Sep, 2016 aortic ulcer intramural hematoma aortic dissection 1. Secondary dissection in the descending aorta after endovascular therapy may demand subsequent interventional procedures. Although spontaneous intramural smallbowel hematoma might be expected to occur with overanticoagulation by heparin, we have not observed this finding and have found no reports describing it. Jul 22, 2010 sicu meeting intramural hematoma 2003.
Many aspects of its natural history remain poorly understood, and the best treatment is not known. Intramural hematoma and penetrating atherosclerotic ulcers of the. Its natural history is variable and still poorly understood, so strategies for therapeutic management are not fully established. The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection ad. We describe five cases, in which transesophageal echocardiography detected intramural hematoma of the aorta. Request pdf hematoma intramural aortico y anticoagulacion intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Birchard clinical history 69yearold female with chest pain. Aortic luminal thrombus and intramural hematoma after.
Thoracic aortic dissection ad is one of the most common aortic emergencies. Intramural hematoma was diagnosed by a variety of highresolution imaging techniques. Atypical presentation of intramural hematoma of the ascending aorta using a conservative approach aortic intramural hematoma is a severe disease, secondary to vasa vasorum bleeding andor aortic microulcers without connection with the true lumen of the vessel. Management of descending thoracic aorta diseases european. Axial noncontrast ct image shows nearcircumferential hig. Intramural hematoma imh of the thoracic aorta only recently has been described in the literature as a distinct entity. However, our case shows that, in individual cases, it is indeed. Intramural hematoma and penetrating atherosclerotic ulcer.
The official publication for icd9cm and icd10cmpcs coding. New development of an ulcerlike projection in aortic. Characteristic findings of an aortic intramural hematoma include a crescentic hyperattenuating fluid collection at unenhanced computed tomography ct and a smooth, nonenhancing, thickened aortic wall at contrast materialenhanced ct. Apr 20, 2017 acute aortic intramural hematoma katherine r. We read with interest the article on the successful diagnostic and treatment of this difficult and rare pathology. Ri slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Intramural hematoma imh of the aorta is recognized as distinct from classic doublebarreled ad. Aortic intramural hematoma radiology reference article. We present the case of a 57yearold woman who had an intramural hematoma of the ascending aorta and aortic arch. Aortic intramural hematoma imh is an acute aortic syndrome with symptoms similar to those of aortic dissection. Hematoma da aorta ascendente intramural hematoma of the. Natural history and ct appearances of aortic intramural. After initial blood pressure control and imaging studies, the patient underwent limited surgical repair that consisted of ascending aortic. David fagnoul, antoine herpain, jeanlouis 1 aortic.
Aortic dissection, aortic intramural hematoma, and penetrating atherosclerotic ulcer of the aorta. Aortic intramural hematoma imh is an important component of acute aortic syndrome. Intramural hematoma and penetrating atherosclerotic ulcer of. Recently, thoracic endovascular aortic repair tevar has.
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 aortic hematoma and anticoagulation request pdf. 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. It is thought to be a direct consequence of vasa vasorum.
Longterm prognosis of patients with type b 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. Intramural hematoma calgary thoracic aorta program. 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. C,typeaaortic dissection,sagittalcontrastenhanced ctarrowheaddissectionplane. Clinical features and longterm outcome of type a and type b intramural hematoma of the aorta. It can be fatal if not promptly diagnosed and treated. Radiological evolution of type b aortic intramural hematoma imh in patient 1. Assessment of clinical and radiological features in comparison to acute aortic dissection1 kwonha yoon, m.
A misdiagnosis may lead to an unnecessary and even hazardous surgical intervention. Intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Intramural hematoma and penetrating atherosclerotic ulcers. The initial ct scan established the diagnosis of type b intramural hematoma confined to the descending thoracic aorta. While, in classical aortic dissection, flow communication occurs though a primary intimal tear and blood propagation creates a false lumen, in intramural hematoma hemorrhage occurs within the. Aortic intramural hematoma and its complications circulation. Whereas many reports combine aortic dissection, intramural hematoma, and paus into the acute aortic syndrome, there are differences in the presentation.
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. When implanting an aortic prosthesis, a sufficient contact between the covered segment and the healthy vessel wall is advisable. Intramural hematoma or aortic dissection a diagnostic and. Advances in imaging techniques have facilitated diagnosis and have aided understanding of the natural history of this entity, practically unknown 10 years ago. Aortic intramural hematoma imh is an entity included in the acute aortic syndrome aas together with aortic dissection and penetrating aortic ulcer 3. 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. 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.
Atypical presentation of intramural hematoma of the ascending aorta using a conservative approach claudia maria rodrigues alves1,2, manuel pereira marques gomes jr. Request pdf intramural aortic hematoma and anticoagulation intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome. Aortic intramural hematoma aha coding clinic icd9cm article. Longterm prognosis of patients with type a aortic intramural. There was eccentric thickening of one wall of the aorta arrowhead that was consistent with thrombus or intramural hematoma. Given the paucity of reports in the literature, it is. The descending thoracic aorta alone was involved in seven patients, whereas the ascending aorta was affected in the other two patients. The common d enominator for this pathology is the disruption of the middle layer with bleeding along the wall of the aorta resulting in separation of the layers or in some cases break trauma. An 85 year old lady presented to us with acute abdomen.
Atypical presentation of intramural hematoma of the. Aortic intramural hematoma has been considered a precursor of overt aortic dissection 1, 2. Intramural blood pools accompanying aortic intramural. 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. The adventitial vv are present in the large elastic vessels with more than 29 lamellae, and are thus found in greater numbers in the ascending aorta, the aortic arch, and the descending aorta, and in smaller quantities in the abdominal aorta. 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. 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 hematoma of the aorta aortic intramural hematoma or atypical aortic dissection is an aortic dissection without intimal tear nor flow communication and it may be the first step of a typical dissection.
This can set a particularly significant challenge for the endovascular specialist. Diagnosis and treatment of thoracic aortic intramural hematoma. 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. Most patients present with spontaneous intramural smallbowel hematoma after having symptoms for several days 1, 2, 7,8,9, 12, 16, 23,24,25. Even though imh is a hemorrhagic lesion, the clinical and morphological evolution was favorable in this subgroup of patients, with canadas mv et al. Hematoma intramural aortico y anticoagulacion revista. Intramural aortic hematoma and anticoagulation sciencedirect.
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. The purpose of this study was to elucidate clinical features and longterm. Intramural hematoma imh represents an emergency condition accounting for approximately 10% to 25% of acute aortic syndromes, most commonly occurring in the descending thoracic aorta 60% to 70% of cases and in older patients 1. Observation surgery open or endovascular persistent or recurrent pain aneurysm formation, hematoma, leaking endograft if intimal defect or leakage baikoussis ng. Ad, intramural haematoma imh, penetrating atherosclerotic.
To the best of our knowledge, there is no report of endoluminal thrombus combined with intramural hematoma associated with cpr in the literature. 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. Overanticoagulation by warfarin is the most common cause of. Hematoma intramural aortico y anticoagulacion sciencedirect. Intramural hematoma imh is a lifethreatening aortic disease included within acute aortic syndrome, together with aortic dissection and penetrating aortic ulcer pau. Observation surgery open or endovascular persistent or recurrent pain aneurysm formation, hematoma, leaking, long longitudinal tear redissection, long longitudinal tear. Intramural hematoma treatment beta blockers to reduce aortic wall stress and control hypertension type a. Endovascular repair of aortic dissection and intramural. Acute aortic syndrome is made up of three entities. Intramural aortic hematoma and anticoagulation intramural aortic hematoma is one of a group of conditions covered by the term acute aortic syndrome.
In addition to an akinetic anterior wall, examination of the aorta, before possible insertion of an aortic counterpulsation balloon in this elderly patient, showed an intramural hematoma and a floating intraluminal thrombus in the descending aorta, at a distance of 40cm from the dental arch. Diagnostics and intramural hematoma treatment interactive. The hematoma around the ascending aorta and aortic root, with associated intimal irregularity at the ascending aorta and small hemopericardium, is compatible with a stanford type a aortic dissection with thrombosed false lumen. No distal propagation into the descending thoracic aorta noted. In the distal segment of the hematoma, a tearshaped image ulcerlike projection was seen within the hematoma figure 2.
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. Download as pptx, pdf, txt or read online from scribd. Computed tomography scan revealed a long loop of markedly thick. Intramural hematoma and penetrating aortic ulcer are uncommon but. Backgroundrecent studies have shown an favorable shortterm prognosis of patients with type a acute aortic intramural hematoma imh. Aortic ulcer intramural hematoma aortic dissection. May 01, 2009 rupture of the vasa vasorum into the media of the aortic wall results in an aortic intramural hematoma.
Findings in spontaneous intramural intestinal hematoma. Transesophageal echocardiography in the diagnosis of diseases of the thoracic aorta. Natural history and ct appearances of aortic intramural hematoma. Intramural hematoma and penetrating atherosclerotic ulcer of the. Spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy.
Pdf we report a case of type a intramural aortic hematoma imh occurred in a 78 years old female. The natural history and outcomes for thoracic and abdominal. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. Lower thresholds can be used for combining surgery on the ascending aorta for. Dec 12, 2008 spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy. Pdf penetrating aortic ulcer and intramural hematoma. It is essential to combine comprehensive imaging diagnostics and their careful interpretation with laboratory examinations and analysis of clinical. Hematoma intramural aortico y anticoagulacion request pdf. Intramural aortic hematoma and anticoagulation revista.
However, the appropriate management of intramural hematoma is neither as well defined nor as widely understood as that of classic dissection. Angiotomography showing intramural hematoma imh compromising the ascending aorta a in a 78yearold patient with acute chest pain. Intramural hematomas in the absence of pau tend to be larger, sometimes compromising the ascending aorta, aortic arch, and descending aorta. She was on warfarin and was found to have grossly deranged clotting parameters. Intramural aortic hematoma and anticoagulation rev esp cardiol. 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. If you continue browsing the site, you agree to the use of cookies on this website. Much uncertainty is caused by the variable natural history of intramural hematoma, which may include the confound.
Treatment patterns and their outcomes of acute aortic. Case reports in medicine hindawi publishing corporation. Recommendations for descending thoracic aorta and thoracoabdominal aortic. Over the last 10 years, intramural haematoma imh of the aorta has become increasingly recognised as a pathological entity distinct from aortic dissection. Aortic intramural haematoma imh, a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of. Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation. Atypical presentation of intramural hematoma of the ascending. 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. A computed tomographic ct scan confirmed these findings. Rupture of the vasa vasorum into the media of the aortic wall results in an aortic intramural hematoma. Computed tomography scan revealed a long loop of markedly thickwalled proximal. To compare the cl inical and radiological features of aortic intramural. Imh also frequently leads to aortic emergency, which can be fatal unless rapidly diagnosed and treated. Pdf acute aortic syndromes include a variety of overlapping clinical and anatomic diseases.
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