Spontaneous progression of ascending aortic intramural hematoma to stanford type a dissection fortuitously witnessed during an MR examination

Aortic intramural hematoma may occur as a primary event (spontaneous dissec tion without intimal flap) or secondary to a penetrating atherosclerotic ul cer. The management of intramural hematoma of the ascending aorta is somewh at controversial because of limited published data, but some centers advoca te early surgical intervention. We describe a patient with an intramural he matoma of the ascending aorta that progressed to a classic communicating di ssection during an MR examination. This case graphically demonstrates the p otential instability of patients with intramural hematoma of the ascending aorta.