Long-term survival and rehabilitation of an inoperable patient with extensive type A aortic intramural haematoma, haemopericardium and haemomediastinum

We present a case about a man in his 70s who was admitted to the emergency department, haemodynamically unstable and with complaints of chest pain and dyspnoea. A bedside transthoracic echocardiography showed enlargement of the aorta and pericardial effusion, and a subsequent CT of the aorta showed acute type A intramural haematoma (IMH). Emergency surgery was not possible due to comorbidities, and a wait-and-watch strategy (optimal medical therapy, with blood pressure and pain control and repetitive imaging) was selected. He was hospitalised for a total of 16 days, during which his condition stabilised. A 3-month follow-up CT showed complete regression of both the IMH and haemopericardium.