[Intramural hematoma in acute aortic syndrome]

Intramural haematoma is the precursor or the variant of a classical aortic dissection where hemorrhage occurs within the aortic wall (aortic media) and in absence of initial intimal tear. This entity looks like a classical aortic dissection, but it differs from it by its pathological characteristics. Although the intimal tear is absent, the prognosis of patients with intramural haematoma is similar to that of patients with classical aortic dissection; it is therefore very important for these patients to be early diagnosed. With a development of modern non-invasive diagnostical techniques the intramural haematoma is more often diagnosed and actually amounts at 10 to 30% of all acute aortic syndrome cases. Clinical characteristics and death rate of patients with intramural hematoma are similar to those of patients with classical aortic dissection, especially when it is obvious that there is a considerable risk for intramural haematoma to complicate into aortic ulcer, aortic aneurysm or rupture. Since intramural haematoma comprehensive diagnostic technique does not exist, safe therapy has not been yet established. Future randomized studies and serial observation of patients with intramural hemorrhage are indispensable not only to clarify these patients' survival predictors but also to define a model of optimal therapy.