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Acute type A aortic dissection following intramural hematoma of the aorta. A case report
Y Moriyama1, K Shiota, K Hisatomi
1Second Department of Surgery, Kagoshima University, Faculty of Medicine, Kagoshima City, Japan.
Insights
Extensive intramural hematoma (IMH) may precede aortic dissection. This case highlights IMH as a potential underlying pathology, evolving into classic type A aortic dissection requiring surgical repair.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Thoracic Surgery
Background:
- Aortic dissection is a serious cardiovascular emergency.
- Intramural hematoma (IMH) is a less understood variant of aortic pathology.
- Early diagnosis and management are crucial for patient outcomes.
Observation:
- A 73-year-old woman presented with symptoms suggestive of aortic dissection.
- Initial CT angiography revealed an extensive IMH from the ascending to descending aorta without intimal tear.
- Recurrent symptoms after two weeks led to a repeat CT, showing a classic type A aortic dissection with intimal defect.
Findings:
- The initial IMH evolved into a distinct intimal tear and false lumen.
- The patient underwent successful hemiarch repair.
- Cerebral perfusion was maintained using profound hypothermic circulatory arrest.
Implications:
- Extensive IMH should be considered a significant precursor to aortic dissection.
- This case underscores the dynamic nature of aortic pathologies.
- Understanding IMH progression is vital for refining diagnostic and therapeutic strategies in aortic diseases.
Abstract:
A seventy-three-year-old woman had symptoms of aortic dissection. Initial computed tomographic (CT) scan and angiography showed an extensive intramural hematoma (IMH) of the aortic segment from the ascending aorta to the bulk of the descending aorta without intimal tear or false lumen. Two weeks later the patient's symptoms recurred. A repeat CT demonstrated a classic type A aortic dissection with a false lumen and an intimal defect. The patient underwent a successful hemiarch repair with use of selective cerebral perfusion under profound hypothermic circulatory arrest. This case suggests extensive IMH as an important underlying pathology of the aortic dissection.