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Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta

Jae-Kwan Song, MD, FACC^*, Hyun-Sook Kim, MD^*, Duk-Hyun Kang, MD^*, Tae-Hwan Lim, MD, Meong-Gun Song, MD, Seong-Wook Park, MD, FACC^* and Seung-Jung Park, MD, FACC^*

^* Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Division of Diagnostic Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Division of Cardiac Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea

View larger version (95K): [in a new window]   Figure 1 Representative X-ray computed tomograms (A and B) and transesophageal echocardiograms at the basal horizontal view (C and D) in proximal aortic dissection and intramural hematoma. ‘Double-channel aorta’ with intimal flap is characteristic in aortic dissection (A and C), whereas crescentic aortic wall thickening without any evidence of flow communication in aortic intramural hematoma (B and D). LA = left atrium; PA = pulmonary artery; RA = right atrium.

View larger version (23K): [in a new window]   Figure 2 Diagram showing initial treatment modalities and in-hospital outcome. AD = aortic dissection; AIH = aortic intramural hematoma; Tx = treatment.

View larger version (108K): [in a new window]   Figure 3 Serial X-ray computed tomograms (CT) in a patient with proximal aortic intramural hematoma (case no. 18). Initial CT (July 12, 1999) showed characteristic crescentic wall thickening in both the ascending and descending aorta with a large amount of pericardial effusion. After emergent percutaneous pericardiocentesis, medical treatment was chosen by the patient, and CT (July 15, 1999) revealed development of pleural effusion. The patient’s condition stabilized rapidly, although the amount of pleural effusion increased (July 29, 1999). One month after the event, complete normalization of the aorta with resorption of pleural effusion was observed (August 9, 1999).

View larger version (93K): [in a new window]   Figure 4 One example of the development of typical aortic dissection in a patient with proximal aortic intramural hematoma (case no. 2). Initially, computed tomography showed dramatic decrease of aortic wall thickening with progressive enlargement of the lumen of the ascending aorta (October 31 and November 12). About two months after the event, she complained of chest pain again and follow-up study revealed development of typical aortic dissection.

View larger version (88K): [in a new window]   Figure 5 One example of the development of focal aortic dissection in a patient with proximal aortic intramural hematoma (case no. 13). With medical treatment, follow-up computed tomography revealed marked improvement of aortic wall thickening with development of typical aortic dissection only in the limited area of the descending thoracic aorta.

View larger version (15K): [in a new window]   Figure 6 Two-year survival rate of proximal aortic intramural hematoma and dissection.