Recently published criteria for the diagnosis of intramural hematoma (IMH)
of the ascending aorta by transesophageal echocardiogram (TEE) include the
presence of a crescent-shaped thickening of the aortic wall of more than 7
mm with an echolucent space. We report a patient whose clinical presentatio
n suggested aortic dissection but whose TEE failed to meet the conventional
criteria for such a diagnosis. TEE showed a uniform intimal thickening sus
picious of IMH but less than 7 mm in thickness and with no echofree space.
One week later, the patient developed frank aortic dissection. Conclusion:
IMH can present with a subtle echo appearance. The diagnosis should not be
totally discounted in the absence of a 7-mm crescentic wall thickness and a
n echofree space if the clinical presentation is suggestive of dissection.