Intramural hematoma of the aorta: diagnosis and treatment

Objective: Increasing use of modern high-resolution imaging techniques yiel ds to describe very early stages of aortic pathology which, if left untreat ed, may lead to overt aortic dissection. One typical example is aortic intr amural hematoma (IMH) with a limited number of cases described in the Liter ature and uncertainties still existing about the most appropriate treatment . Purpose of our study is to report our experience in the evaluation and tr eatment of IMHs. Methods: From 1991 to 1999 175 patients were conveyed to o ur centre for aortic dissection: in nine of them diagnosis of acute IMH was performed. Results: Diagnosis was obtained by means of conventional CT sca n of the chest. All the patients underwent surgery, one patient died (11%). At the follow-up (mean 31 months) eight patients were alive and well and d id not require any other cardiac surgery. Conclusions: The possibility to p rogress to overt aortic dissection may explain the need to an early diagnos is in the treatment of acute IMHs. Immediate surgical treatment is, in our experience, the preferred therapeutic option. (C) 2001 Elsevier Science B.V . All rights reserved.