Acute Intramural Hematoma of Aorta: Still Mystery for Debate

I-Chung Chen ； Chih-Hui Chin ； Chung-Huo Chen

《Journal of Medical Ultrasound》 18卷1期 (2010/03) Pp. 11-26

並列摘要

Aortic intramural hematoma (IMH) is defined as aortic dissection without identifiable intimal tear and lack of flow in the false lumen of the aorta. Hematoma forms within the aortic wall as a result of either vasa vasorum hemorrhage, a microscopic tear of the intima that is not detectable by imaging modalities or an atherosclerotic plaque with penetrating ulceration rupture. Type A aortic IMH is defined as involvement of the ascending aorta. Type B aortic IMH is defined as involvement of only the descending aorta. The diagnosis is confirmed by computed tomography (CT) scan, magnetic resonance imaging and/or transesophageal echocardiography (TEE). The regional thickening of the aortic wall greater than 7 mm with evidence of intramural blood accumulation is considered IMH. The management of acute type A IMH is still controversial. Asian cohort used serial scans to monitor complications, which was then used to determine the timing of surgery. The treatment policy of institutions was initial medical treatment with timed surgical intervention in cases with complications, according to clinical assessment and on followup imaging studies. The initial therapeutic goal during the acute phase of IMH included the elimination of pain and the reduction of systolic blood pressure to 100-120 mmHg. Close clinical monitoring with transthoracic echocardiography, TEE, and CT scan is carried out to minimize the risk of fatal complications. Aortic diameter ＞ 5.0 cm and hematoma thickness ＞ 12 mm are independent predictors of development of complications and may benefit from urgent surgery. In addition, regression may occur but is less common and not predictable in proximal IMH involving the ascending aorta. Therefore, IMH involving to the aortic valve is usually related to acute mortality and needs early surgical approach. Type B IMH are generally associated with favorable outcome as compared with type A lesion. There was no difference in survival between medical vs. surgical management in patients with type B IMH.

並列關鍵字

aortic dissection ； intramural hematoma