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Aortic Intramural Hematoma
Santiago Martínez-Jiménez, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Intramural hematoma (IMH)
            • Definitions

              • Acute aortic syndrome comprises aortic dissection (AD), incomplete AD (ID), penetrating aortic ulcer (PAU), and IMH
              • IMH (or class 2 AD)
                • Absent or very small entrance tear and absent reentrance tear
                • a.k.a. noncommunicating dissection
              • PAU (or class 4 AD)
                • Ulcerated atherosclerotic lesion that penetrates internal elastic lamina
                • ± IMH

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Echocardiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        Selected References

                                        1. Gutschow SE et al: Emerging concepts in intramural hematoma imaging. Radiographics. 36(3):660-74, 2016
                                        2. Valente T et al: MDCT distinguishing features of focal aortic projections (FAP) in acute clinical settings. Radiol Med. 120(1):50-72, 2015
                                        3. Akin I et al: Penetrating aortic ulcer, intramural hematoma, acute aortic syndrome: when to do what. J Cardiovasc Surg (Torino). 53(1 Suppl 1):83-90, 2012
                                        4. Harris KM et al: Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation. 126(11 Suppl 1):S91-6, 2012
                                        5. Kitai T et al: Detection of intimal defect by 64-row multidetector computed tomography in patients with acute aortic intramural hematoma. Circulation. 124(11 Suppl):S174-8, 2011
                                        6. Wu MT et al: Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course. Radiology. 258(3):705-13, 2011
                                        7. Vilacosta I et al: Acute aortic syndrome: a new look at an old conundrum. Postgrad Med J. 86(1011):52-61, 2010
                                        8. Wu MT et al: Images in cardiovascular medicine. Multislice computed tomography of aortic intramural hematoma with progressive intercostal artery tears: the Chinese ring-sword sign. Circulation. 111(5):e92-3, 2005
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Intramural hematoma (IMH)
                                                  • Definitions

                                                    • Acute aortic syndrome comprises aortic dissection (AD), incomplete AD (ID), penetrating aortic ulcer (PAU), and IMH
                                                    • IMH (or class 2 AD)
                                                      • Absent or very small entrance tear and absent reentrance tear
                                                      • a.k.a. noncommunicating dissection
                                                    • PAU (or class 4 AD)
                                                      • Ulcerated atherosclerotic lesion that penetrates internal elastic lamina
                                                      • ± IMH

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Echocardiographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              Selected References

                                                                              1. Gutschow SE et al: Emerging concepts in intramural hematoma imaging. Radiographics. 36(3):660-74, 2016
                                                                              2. Valente T et al: MDCT distinguishing features of focal aortic projections (FAP) in acute clinical settings. Radiol Med. 120(1):50-72, 2015
                                                                              3. Akin I et al: Penetrating aortic ulcer, intramural hematoma, acute aortic syndrome: when to do what. J Cardiovasc Surg (Torino). 53(1 Suppl 1):83-90, 2012
                                                                              4. Harris KM et al: Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation. 126(11 Suppl 1):S91-6, 2012
                                                                              5. Kitai T et al: Detection of intimal defect by 64-row multidetector computed tomography in patients with acute aortic intramural hematoma. Circulation. 124(11 Suppl):S174-8, 2011
                                                                              6. Wu MT et al: Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course. Radiology. 258(3):705-13, 2011
                                                                              7. Vilacosta I et al: Acute aortic syndrome: a new look at an old conundrum. Postgrad Med J. 86(1011):52-61, 2010
                                                                              8. Wu MT et al: Images in cardiovascular medicine. Multislice computed tomography of aortic intramural hematoma with progressive intercostal artery tears: the Chinese ring-sword sign. Circulation. 111(5):e92-3, 2005