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Kim, Chung, Rim, Kim, Hong, Ha, Kwan, Lee, Lee, Shim, Cho, Kim, and Lee: The Clinical Presentation and Course of Intramural Hematoma of Aorta
Original Article

J Korean Soc Echocardiogr 1995;3(2):188-195.

Published online: 18 February 1995

DOI: https://doi.org/10.3803/jkes.1995.3.2.188

The Clinical Presentation and Course of Intramural Hematoma of Aorta

Geon-Young Kim, M.D., Nam-Sik Chung, M.D., Se-Joong Rim, M.D., Jong-Hyeon Kim, M.D., Bum-kee Hong, M.D., Jong-Won Ha, M.D., June Kwan, M.D., Moon-Hyoung Lee, M.D., Young-Joon Lee, M.D., Won Heum Shim, M.D., Seung Yun Cho, M.D., Sung Soon Kim, M.D., Do-Yun Lee, M.D.∗

Cardiology Division, Yonsei Cardiovascular Center, Yonsei University, Seoul, Korea

∗Dept. of Radiology, Yonsei Cardiovascular Center, Yonsei University, Seoul, Korea

Copyright © 1995 Korean Society of Echocardiography

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aortic intramural hematma(IMH) has been known as a variant of acute aortic dissection without intimal rupture. The clinical presentation mimics that of acute aortic dissection. IMH may progress to frank aortic dissection or aortic rupture. Therefore IMH maybe regarded as early sign of developing classic aortic dissection or a precipitating factor. There are important two questions. The first is whether IMH truly represent a different pathology or simply the precursor of the conventional aortic dissection. The second is what the optimal mode of management of IMH is. In this study, To answer these questions, We retrospectively performed this study. Fifteen patients of IMH were included. We could follow 12 patients. Among them extention of IMH to type III aortic dissection has been observed in 2 cases(1 type A and 1 type B).
One patient of type A underwent aortic graft stent deployment successfully. In the other patient of type B, who had a history of myocardial infarction and longstanding heart failure by that time, dissection developed at abdominal aorta with renal arterial involvement. The patient died of multiorgan failure despite intensive conservative managements. The remaining ten patients are alive with only medical care and with good clinical outcome. In conclusion we feel that conservative treatment of patients with IMH result in favorable outcome relatively even in the cases involving the ascending aorta. But more longterm follow-up of larger number of patients will provide better guidelines regarding the proper management of IMH.

Keywords: Intramural hematma, Clinical presentation, Follow up, Mode of treatment.

References

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Table 1.
Demographic and Clinical Data's of the patients
  Sex Age Lesion site Symptom Sx. duration F/U duration F/U tool Aortic lesion∗
1 m 78 des 흉통 2 시간 15 C – T +
#2 f 71 asc-des 흉통 2 5 C – T, TEE  
3 f 74 arch-des 배부동 2 – – +
4 m 54 asc-des 흉통 44 – –  
5 f 66 arch-des 흉풍 7 5 TEE  
6 f 76 asc-des 배부똥 2 7   +
7 m 44 des 배부동 72 – –  
8 f 64 des ”H부흉 6 2    
9 m 78 arch-des 흉용 2 26 C-T +
in m 69 des 배부풍 2   –  
11 m 55 asc 흉용 7 46 C-T +
12 m 63 asc-des 배부동 12 29 C-T +
13 m 58 asc-des 흉흉 3 11 C-T  
14 f 61 des 흉풍 1 11 C-T  
@15 m 72 des 흉통 3 2 TTE  

∗ aorta 의 dilated or aneurysmal change. F/U; follow up

’복부대동맥에 대동맥박리가 발생하여 대동맥내에 스텐트관 삽입하여 지료하였다.

@IMH로 진단받고 2개월후 복부대동맥에 대동맥박리가 발생하였으며 다발성 장기부천으로 사망하였다.

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