Aortic Intramural Hematoma Leading to Emergent Aortic Dissection: A Case Report

Abstract Introduction: Acute aortic syndromes (AAS), encompassing intramural hematoma (IMH), pose serious threats to the aortic wall. IMH, defined by blood within the aortic medial layer without an overt intimal tear, holds significance in the AAS spectrum. This case report explores the diagnostic and management challenges of IMH, emphasizing the need for personalized approaches. Case report: A 62-year-old male with chest pain underwent computed tomography angiography revealing a mural thrombus in the ascending and aortic arch. Urgent surgical intervention was deemed necessary due to an ascending aortic hematoma (58 mm diameter, 15 mm thickness). A saccular aneurysm in the descending aorta prompted semi-elective Thoracic Endovascular Aortic Repair (TEVAR). Discussion: IMH's elusive nature complicates its diagnosis compared to more identifiable conditions like aortic dissection. Stanford and DeBakey classifications guide treatment decisions based on the IMH type. Predictive factors for fatal events include low systolic blood pressure, pericardial effusion, an ascending aortic diameter exceeding 45 mm, and the existence of Ulcer-Like Projection (ULP) in the ascending aorta. Long-term survival rates for Type A IMH surpass those for classic Type A aortic dissection. Conclusion: Managing IMH within AAS requires personalized approaches. Factors predicting fatal events underscore the significance of early identification. This case highlights the urgency of surgery for ascending aortic hematoma, contributing to a better understanding of AAS for future research and clinical practice. Keywords: Aortic intramural hematoma; Acute aortic sydromes; Aortic dissection; Thoracal endovascular aortic replacement