Intramural aortic hematomas

Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wal l. In general a traumatic form can de differentiated from a spontaneous non -traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imagin g modalities. Acute and subacute discomfort associated with a tendency of c ollaps are considered as typical presenting complaints. A semicircular or c oncentric thickening of the aortic wall with the absence of blood flow or a dissection membran are typical findings in transesophageal echocardiograph y, computed tomography and magnetic resonance tomography. From a differenti al diagnostic point of view a distinction from atherosclerotic wall changes , intraluminal thrombi and inflammatory aortic diseases is essential. The I MH is considered as an early presentation of aortic dissection, put into an d treated according to the Stanford classification. In the course of natura l history an IMH can disappear, rupture or progress into a classic aortic d issection.