Should ascending aortic intramural hematoma be treated Surgically?

Aortic intramural hematoma (IMH) was first described by Krukenberg in 1920( 1) and is characterized by the absence of an intimal tear and false lumen t hat are the main characteristics of classic aortic dissection. This variant form of aortic dissection can not be diagnosed by angiography.(2) Magnetic resonance imaging (MRI),(3,4) computed tomography (CT),(5,6) and transesop hageal echocardiography (TEE)(7,8) represent recent advances in the noninva sive diagnosis of aortic dissection. However, without recognition of this v ariant form of aortic dissection, one could erroneously make the diagnosis of aortic aneurysm with mural thrombus. Despite these challenging aspects o f diagnosis, once the diagnosis is established, the recommended treatment s trategy is not very different from classic aortic dissection. Surgical trea tment has been recommended for type A and medical treatment for type B IMH. (9-12)