Intramural hematoma of the aorta is a condition increasing ly observed in c
linical practice. Uncertainty exists whether such lesions represent a diffe
rent pathology or simply the precursors of classic dissecting aneurysm. The
patient was a 76-year-old woman with intramural hematoma of the ascending
aorta. Clinical course, progression of the lesion to type A aortic dissecti
on, and surgical treatment are described. Although natural history of intra
mural hematoma of the ascending aorta is not clearly elucidated, the case p
resented confirms that the evolution toward intimal nap formation is possib
le and that we cannot foresee the stabilization of these lesions. We stress
that intramural hematoma of the ascending aorta has to be managed as an ao
rtic type A dissection and that aggressive treatment is advisable. (C) 1999
by The Society of Thoracic Surgeons.