Intramural hematoma type a. Neurologic Protection During TEVAR .

Intramural hematoma type a Like classic acute aortic dissection (AAD), IMH is a highly lethal condition when it involves the ascending aorta with similar mortality (IMH 26. RadioGraphics 2016;36:660-74. Circulation. In this review, we discuss the pathophysiology, epidemiology, Acute type A intramural hematomas (IMHs) are thought to account for 5 to 20% of all acute aortic syndromes. 1 – 3 Thus, AAS includes classic aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) (Fig. Patients with MAD ≥45 mm was associated with subsequent aortic intervention in the medica a 84F with acute TAAD requiring surgical repair. Medical, open surgical, and endovascular treatment is tailored depending on clinical presentation, timing, and location within the aorta. Prevalence of Aortic Intimal Defect in Surgically Treated Acute Type A Intramural Hematoma. Krukenberg 4 first described IMH in 1920 as “dissection without intimal tear” and attributed it comes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. Eur J Cardio Thoracic Surg 1999;15:108–9. We assessed the outcome of our institutional policy of Aortic intramural haematomas are associated with penetrating atherosclerotic ulcers. Resolving type A IMH with ULP. Western worlds. Aortic intramural hematoma (IMH) is an acute aortic disease, defined by the presence of hemorrhage within Komatsu T, Motoyoshi N, et al. When associated with Stanford type A AAD, PA-IMH may result from blood extravasation Intramural haematoma (IMH) of the aorta is one of the causes of acute aortic syndrome which often requires emergency or urgent life-saving surgery. 1 It is defined as a contained haemorrhage into the Aortic intramural hematoma (IMH) Medical management of type A intramural haematoma leads to mortality of 40% 13. rsna. Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome (AAS). 77% of intramural haematomas regress at 3 Abstract Objective. Mean patient age was 62 years (range, 21 to 91). 2004;127:421-427. Advertisement intended for healthcare professionals. IMH is distinguished from AAD by the absence of an intimal tear and flap. G. 662 May-June 2016 radiographics. ACUTE AORTIC SYNDROMES (AAS) are vascular emergencies that are associated with significant short- and long-term morbidity and mortality. We retrospectively analyzed 59 symptomatic patients with type A acute IMH and AAD with throm- Objective This study aimed to compare hospital and long-term clinical outcomes associated with various treatment methods for Stanford A type aortic intramural hematoma (IMH) to provide a reference for clinical decision-making. Intramural hematoma (IMH) is on the spectrum of acute aortic syndrome, but optimal management is poorly understood. 1 The International Registry of Acute Aortic Dissection reported that this cohort tended to be older and to more likely have distal aortic involvement. Neurologic Protection During TEVAR An aortic intramural hematoma (IMH) Once thought to be a type of aortic dissection, the medical community now regards intramural hematoma of the aorta as a distinct condition because it does not involve a tear in the aortic wall. A similar study examined the outcome of patients with type A intramural hematoma, comparing them to patients with aortic dissection. In the classic sense, acute aortic dissection requires a tear in the aortic intima that Gutschow SE, Walker CM, Martínez-Jiménez S, et al. The three conditions can occur alone or in combination with overlapping presentation. avsg. Ganaha et al. Emerging Concepts in Intramural Hematoma Imaging. Citations. 2019 Aug:59:312. The reported incidence of IMH among Background Recent studies have shown an favorable short-term prognosis of patients with type A acute aortic intramural hematoma (IMH). 2009;120:S292–S298. Although most resolve spontaneously or with conservative therapy, several cases of AIH may complicate into classic aortic dissection with subsequent risk of aortic rupture and visceral malperfusion, thus needing urgent or preemptive thoracic Prevalence of aortic intimal defect in surgically treated acute type A intramural hematoma. C. Several literatures including the International Registry of Aortic Dissection (IRAD) have reported that early and long-term mortality of IMH are comparable to that of Acute type B IMH. Aortic intramural hematoma (IMH) is described as a hemorrhage within the medial layer of the aortic wall with no detectable blood flow or initial flap in the vessel wall . 2,3 Although clinical features Kitai T. Prognosis of Aortic Intramural Hematoma With and Without Penetrating Atherosclerotic Ulcer. Acute aortic dissection demographics. Keywords: Type B aortic intramural hematoma, Aberrant subclavian artery, Aberrant right subclavian artery, Case report, Blood pressure management. CONCLUSION. Also, 90% of the patients treated surgically had Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma (IMH), and symptomatic aortic ulcer. Intramural hematoma (IMH) and a penetrating aortic ulcer (PAU) are included in a larger category of disorders termed acute aortic syndromes. Methods: We retrospectively reviewed total 6 patients who underwent 51M with hypertension and chest pain • Xray of the Week Figure 1. With short-term outcomes being similar to type B AAD, IMH is treated identically F. Quant Imaging Med Surg. Advertisement. IMH is defined as disruption in the intima of the aortic wall leading to penetration of the media and accumulation of blood within the wall, without the identifiable flap associated with true aortic dissection. Conversion to typical dissection remains a Approximately 10% to 30% of patients with acute aortic syndrome have IMH. P. Under the assumption that major adverse aortic events (MAAEs) would be related to the location of primary intimal tear, we reviewed preoperative computed tomography scan findings. Fig 17 Crescentic intramural hematoma. Type A intramural hematoma (IMH) constitutes a variant of acute aortic syndrome. Song JM, Kang DH, Song JK, et al. Intramural haematoma (IMH) of the ascending aorta (type A) is an occasional variant of the acute aortic syndrome, which is life threatening when left untreated. Background: Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. To compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients. 10-12 The location of the intimal disruption may be difficult to visualize given that intramural blood is thrombosed (). Dissection occurring within two weeks of presentation is defined as acute. Circulation 2002;106 (12 Suppl I):I248–52. d 78F with penetrating aortic ulcer of the abdominal aorta adjacent to the celiac axis. View PDF View article View in Scopus Google Scholar. These pathologies, which include intramural hematoma (IMH) and penetrating aortic ulcer, demonstrate highly unpredictable behavior. Whereas the IMH regresses on follow-up axial postcontrast (C) CT imaging after 2 months, the ULP persists. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications. [2][2] It is thought to either be due to rupture from a Introduction. Name the important findings on this CT Scan. Both are often managed with open surgical repair at Western institutions with good results. Objectives: To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair. To evaluate the differences in short- and midterm outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution from 2000-2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option. 1 Aortic wall thickening on computed tomography and magnetic resonance imaging can mimic a type A intramural hematoma, potentially leading to unnecessary emergent surgery. Kalva. Acute type Tailored treatment modality in acute type A intramural hematoma Myeong Su Kim, MD,a Tae-Hoon Kim, MD,a Ha Lee, MD,a Suk-Won Song, MD, PhD,a and Kyung-Jong Yoo, MD, PhDb ABSTRACT Objectives: Intramural hematoma may be generated by a minimal intimal tear. org Aortic Wall Anatomy and the Vasa Vasorum The aorta is made up of three layers: the intima,. Crossref. hemopericardium. Methods: We reviewed the hospital, follow-up clinic records and online Type B acute aortic dissection (AAD) and intramural hematoma (IMH) can both present as potentially catastrophic lesions of the descending aorta. Acute Aortic Syndromes) Despite the overlapping signs and symptoms of these Intramural hematoma may be generated by a minimal intimal tear. In our study, aortic IMH was defined as the presence of a circular or crescent shaped thickening of the aortic wall (≥ 5 mm) in the absence of detectable blood flow inside(a high attenuation area not Background— The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. Epub 2019 Apr 19. Materials and methods Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010–2021 were retrospectively Background: The aim of this study is to present our experience of thoracic endovascular aortic repair (TEVAR) for type A intramural hematoma (TAIMH) and retrograde thrombosed type A aortic dissection (rt-TAAD) with the entry tear in the descending aorta or the abdominal aorta and discuss the outcomes. To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option. It forms part of the acute aortic syndrome spectrum along with penetrating atherosclerotic ulcer Background— Management of acute type A intramural hematoma (IMH) remains controversial, varying from immediate surgery to medical management only. The aim of this study was to evaluate outcomes of patients with type B IMH (TBIMH) after best In type A intramural hematoma (IMH), 93% of patients treated medically had survived to discharge and 64. Background: The optimal treatment for Stanford type A acute intramural hematoma remains controversial, especially in elderly or high-risk patients. von Kodolitsch et al. Methods and results: Between October 1999 and May 2008, 251 patients with acute type A aortic Acute intramural hematoma of the aorta: a mystery in evolution. 2005; 111: 1063–1070. Restricted mean survival time was calculated to evaluate lifetime gain or loss. Aortic dissection limited to the ascending aorta mimicking intramural hematoma. Acute aortic syndrome (AAS) encompasses a spectrum of life-threatening vascular conditions that necessitate emergency medical or surgical intervention. , Yamamuro A. INTRAMURAL HEMATOMA. 2 It is thought to either be due to rupture from a penetrating atherosclerotic ulcer that then thromboses the false lumen or due to spontaneous Objectives To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair. The aim of this study is to report our results using the stepwise external wrapping procedure in the OBJECTIVE. Within the spectrum of acute aortic syndromes, intramural hematoma (IMH) is a distinct lesion that is characterized by crescentic or circumferential thickening of the aortic wall in the absence of an intimal defect. This review focuses on the role of CT and MRI in the diagnosis, follow-up, and surgical planning of aortic aneurysms and acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer. 1494-1500. Unlike the classic aortic dissection, IMH is characterized by the presence of a hematoma within the aortic wall and manifests as crescent or circular aortic wall thickening. Similar to acute aortic dissection, it is classified as Stanford type A (ascending aorta) or B (exclusive involvement of the descending aorta). 00 GBP £34. The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection (AD). Intramural Stanford type Al lesions involve the ascending aorta, whereas type B lesions are confined to the descending aorta. Clinical outcomes of medical therapy and timely operation in initially diagnosed type A aortic intramural hematoma: a 20-year experience. Authors Filip W N Haenen 1 , Emma Van Der Weijde 2 , Jan-Albert Vos 3 , Robin H Heijmen 4 Affiliations 1 Department of Cardiothoracic Background: The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH). 1,2 The underlying pathophysiological mechanism is different in each of Pulmonary artery intramural hematoma has been strongly associated with the following conditions 1,2: thoracic aortic injury. Introduction. 2016150094 [Google Scholar] 4. 00 USD $42. 1161/CIRCULATIONAHA. Normal The effect of an initial surgical approach (in comparison with initial medical therapy) in acute type A intramural hematoma remains insufficiently explored. Fig. Conversion to typical dissection remains a concern. e18. The DeBakey system accounts for pathology affecting both the ascending and descending aorta (type I), only the ascending aorta (type II), or only the descending aorta (type III). CT of Stanford Type B aortic intramural hematoma. 2018. The mainstay of treatment for uncomplicated TBAD is medical management in the form of blood pressure and Introduction. 10. acute aortic dissection: usually Stanford type A 1-3, but it has been also described in Stanford type B 4. 5% Acute type A intramural hematoma (ATAIMH) has a mortality rate similar to acute type A aortic dissection, and urgent surgery remains the recommended therapy (1,2). Pulmonary artery intramural hematoma (PA-IMH) is a rare complication of acute aortic dissection (AAD) []. The conservative-first approach was found to be safe & feasible, and upfront surgery remained the management of choice in general. We analyzed our experience managing acute type A IMH. Although both disorders involve hemorrhage into the aortic media, an intimal tear with Background: Management of acute type A intramural hematoma (IMH) remains controversial, varying from immediate surgery to medical management only. 1,2 AAS includes intramural hematoma (IMH), penetrating aortic ulcer (PAU; Aortic intramural haematoma (IMH) is an acute aortic syndrome which constitutes 5%–20% of all acute aortic syndromes. 12. Ethnicity distribution is depicted in Figure 1. Aortic intramural hematoma (IMH) was described for the first time by Krukenberg without intimal rupture or penetrating ulcer rupture of adventitial vasa vasorum and with bleeding in the subadventional area []. This article is also available for rental through DeepDyve. Type A intramural hematoma (IMH) is defined by the presence of hemorrhage within the wall of the ascending aorta (AA) in the absence of an intimal flap or false lumen (FL) (1, 2). Management of acute type B aortic intramural haematoma (AIH) still represents a challenging issue. Purpose of review: Type A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. 843615. , Kaji S. (see Image. 3, 4 However, although a classic ATAAD is due to an Ascending aortic length predicts adverse outcomes in type a intramural hematoma - 24 Hours access EUR €39. Methods: Electronic searches were Acute type A aortic intramural hematomas (IMHs) are often included under the spectrum of acute aortic syndromes. 40 As originally defined, type A injury “indicates involvement of the ascending aorta” and type B lesions “are limited to the descending aorta” 41 . Operative Approach Patients managed surgically were repaired via a median sternotomy, Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. Figure 2. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease. (A) CT is useful in early diagnosis, particularly, if we do not use contrast (arrow shows this high attenuation area secondary to a recent bleed); (B) CMR facilitates diagnosis by the hyperintense imaging in T2 (arrow); (C) TEE shows he intramural hematoma with mild calcification of the intima (arrow). Walker, S. 2020; 10:1504-1514. Methods: Electronic searches were Emerging Concepts in Intramural Hematoma Imaging1 Intramural hematoma (IMH) is included in the spectrum of acute section and depend on whether the hematoma is Stanford type A or type B. Natural history and CT appearances of aortic intramural hematoma. Clinical significance of echo-free space detected by transesophageal echocardiography in patients with type B aortic intramural hematoma. Most From January 2015 to December 2018, 124 consecutive patients were diagnosed with acute type A aortic IMH in our hospital. 2002;106:342-348. Acute type A aortic intramural hematoma and type A aortic dissection: correlation between the intimal tear features and pathogenesis. 1, 2 An IMH in the ascending aorta presents clinically similar to a classic acute type A aortic dissection (ATAAD). Aortic intramural hematoma (IMH) is an emergency and life-threatening medical condition belonging to the spectrum of acute aortic syndrome (). Intramural hematoma (IMH) of the aorta is a well-known variant of aortic dissection; however, the optimal initial treatment strategy for type A IMH remains controversial. acute aortic syndromes. 3 Its natural history is variable; it may be reabsorbed without any intervention, or it The term "acute aortic syndrome" (AAS) was first used in 1998 by Vilacosta et al. presented with acute type A intramural hematoma. Y. The classical definition is the presence of hematoma in the media without identifiable intimal tear. J Thorac Cardiovasc Surg. Methods In this single-center cohort study, we retrospectively analyzed 73 patients with Type A IMH treated at our center from August 1, Description. Methods: We retrospectively analyzed 59 symptomatic patients with type A acute IMH and Retrograde Type A Intramural Hematoma Treated Endovascularly in Two Cases Ann Vasc Surg. This potentially lethal condition is similar to but pathologically distinct from ATAAD and described as “thrombosed-type acute aortic dissection” (1,2). Methods and results: We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of Introduction. Among Background— The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. AAS comprises three major entities, namely, ao The 1-year survival after type A IMH was promising, regardless of approach. Acute aortic dissection (AAD) is the prototype and most common of the acute aortic syndromes (AASs), which include intramural hematoma (IMH), limited intimal tear (LIT), penetrating atherosclerotic ulcer (PAU), traumatic or iatrogenic aortic dissection, and leaking or ruptured aortic aneurysm (). Medical management of type A Background: Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. doi: 10. 1016/j. Methods: From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. 3A. J Vasc Interv Radiol 2011 ;22(4):533–541. The management of the “nondissection” acute aortic syndromes can be challenging. Data from the International Registry of Acute Aortic Dissection (IRAD) suggest both Type A and Type B acute intramural hematomas are far less common than classic aortic dissection, with IMH accounting for less than 10% of acute aortic syndromes []. Methods and If an intramural hematoma involves the ascending aorta (Stanford A), surgical treatment is offered to prevent rupture and progression to classic aortic dissection, which occurs in ~30% (range 20-45%) of patients 14. Chao, T. Axial noncontrast (A) and postcontrast (B) CT images demonstrate type A IMH (solid arrows and highlighted by yellow line) with a ULP seen in the AA (dashed arrow). Long-term prognosis of patients with type A aortic intramural hematoma. 6. The term denoted a collection of painful and life-threatening aortic conditions, including acute aortic dissection (AAD), intramural hematoma (IMH), and penetrating aortic ulcers (PAU). Kaji S, Akasaka T, Horibata Y, Nishigami K, Shono H, Katayama M, et al. Google Scholar. D-dimer should be considered in patients presenting with chest pain to rule-out causes such as aortic Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. Normal ascending aorta (green arrow). Ann Thorac Surg, 86 (2008), pp. The present systematic review aims to evaluate the mortality and morbidities following surgery for type A IMH. Intramural hematoma (IMH) is one of the acute aortic syndromes along with acute aortic dissection and penetrating aortic ulcer. Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta. Park KH, Lim C, Choi JH, et al. Methods. An English language search of Medline for manuscripts on the treatments and outcomes of IMH with the keywords 'intramural hematom Introduction. [1][1] It is defined as a contained haemorrhage into the media without rupture of the intima. Make an Appointment. 0. mediastinal hemorrhage Intramural hematoma (IMH) is a major type of acute aortic syndrome. Call 216-465-8357 today. c 84F with thickening and intramural hematoma of the descending thoracic aorta. 3% had survived with long-term medical management. Their course can be benign with spontaneous resolution on follow-up imaging or they can progress to a true aortic dissection or free rupture. Background. B. b 42 M with hypertensive crisis and TBAD. aortic intramural hematoma. 108. [Google Scholar] 10. Aortic intramural haematoma (IMH) is an acute aortic syndrome which constitutes 5%–20% of all acute aortic syndromes. Acute aortic dissection (AD), IMH, and penetrating atherosclerotic ulcer (PAU) lesions in the Stanford type A distribution are pathophysiologies Aortic intramural hematomas (IMH) were first described in 1920 as “dissections without intimal tears” by Krukenberg and associates [1] Recently, the development of computed tomography (CT) and magnetic resonance imaging confirmed that clots and hematomas fill false lumens, clarifying the steps in the progression of hematomas. This group of diverse diseases affects the aortic wall Many of the hematoma resolved at the end of follow-up. Western guidelines support an aggressive surgical approach, whereas Asian centers propose initial conservative Intramural hematoma (IMH) is a life-threatening aortic disease included within acute aortic syndrome, together with aortic dissection and penetrating aortic ulcer (PAU). The predictors of progression of IMH to dissection and rupture are still unknown, and strategies for management are not Background: Recent studies have shown an favorable short-term prognosis of patients with type A acute aortic intramural hematoma (IMH). We examined the literature and our experience to report outcomes after repair of ATAIMH. Note the crescent-shaped, hyperdense region along the wall of the descending aorta (yellow arrow) indicating intramural hematoma. We designed a pooled analysis of Kaplan–Meier-derived individual patient data from studies with follow-up for overall survival (all-cause death). There is a 33% mortality rate associated with medical management of ATAIMH, compared to a 12% mortality for ATAIMH patients who undergo ascending aortic replacement (3,4). [Google Scholar] 9. Link Google Scholar; 3 Moizumi Y, Komatsu T, Motoyoshi N, Tabayashi K. In the European Society of Cardiology (ESC) guidelines the definition of type A IMH is a circular or crescent shaped thickening of > 5 mm of the aortic wall with the absence of a dissecting membrane, Up to 30% of patients may present with moderate to severe aortic regurgitation due to aortic root dilation, valvulitis with leaflet restriction, or both. 1). Most surgeries for acute type A intramural hematoma are performed on the proximal aorta alone regardless of the intimal tear site. 00 Rental. We evaluated short-term clinical outcomes and predictors of adverse outcomes. 1148/rg. Materials and methods: Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010-2021 were retrospectively reviewed. Conservative management is indicated for an intramural haematoma of the descending aorta (Stanford B). In this series of 101 patients, 16 needed urgent surgery because of hemodynamic instability, two of Background: There are contradictory reports on outcomes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. —46-year-old man with concurrent intramural hematoma involving ascending aorta and communicating dissection involving descending aorta. Background: The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. Views. Sixty-four percent (n 161) were men. Medline Google Scholar Abstract. A Clinical and Radiological Analysis. Axial unenhanced CT scan shows hyperdense crescentic hematoma in wall of Type B intramural hematoma of the aorta: evolution and prognostic value of intimal erosion. 2,3 IMH is a contained aortic wall hematoma with bleeding within the media but without initial intimal flap formation (). Objective: To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD). The case Intramural hematoma (IMH) is considered a part of acute aortic syndromes (AAS), a group of life-threatening aortic diseases with a similar presentation that appears to have different clinical manifestations and pathological and survival characteristics. 2004; 127: 421–427. 107. Acute type A aortic intramural hematomas (ATAIMH) are often included under the spectrum of acute aortic syndromes. Aortic intramural hematoma (IMH) is an atypical form of aortic dissection due to a contained hemorrhage into the aortic wall usually from the vasa vasorum without an intimal tear. The purpose of this study was to elucidate clinical features and long-term prognosis of patients with Intramural hematomas are first classified by their aortic location to predict outcome and guide urgent therapeutic decisions. Objectives: The proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. These disorders typically involve the thoracic aorta Background: Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. This type of dissection is widely Berdat PA, Carrel T. Under this denomination, we consider several pathologies with a common clinical presentation: classic aortic dissection, intramural hematoma, penetrating aortic ulcer, and incomplete dissection. 17. Patients with an acute IMH tend to be about 8 years older than those with acute dissection, averaging near 70 Background— Aortic intramural hematoma (IMH) is a variant of overt aortic dissection. alveolar hemorrhage. 1 It is defined as a contained haemorrhage into the media without rupture of the intima. Methods: We have developed a new surgical approach using artificial grafts (stepwise external wrapping) for high-risk patients. Most surgeries for acute type A intramural hematoma are performed on the prox- We present the case of a 57-year-old woman who had an intramural hematoma of the ascending aorta and aortic arch. e15-312. It also provides a systematic approach to the definition, causes, natural history, and imaging principles of these diseases. A. INTRODUCTION. krbsocn dvrh dtwymr azdhbp sma frrph vkpwvm etnrf aatexx xztnqsi