Aortic Intramural Hematoma Diagnosed in the Emergency Department

ABSTRACT

PURPOSE: An aortic intramural hematoma (AIH) is a medical disease known to be a variant form of an aortic dissection without intimal tearing. Although it is not often encountered in the emergency department (ED), emergency physicians have to differentiate it from other aortic diseases or ischemic heart disease because the disease processes are similar and/or the symptoms, such as sudden chest pain, are the same. For that reason, we evaluated the clinical and radiological characteristics of AIH, as well as its treatment plans, complications, and follow-up results. METHODS: From 1995 to September 2002, a total of 30 patients were diagnosed with AIH by using computerized tomography (CT) in the Emergency Department, Yeungnam University Hospital. We reviewed the clinical charts and X-ray films retrospectively and evaluated the clinical features, the hospital courses, and the follow-up results. Also, we divided the patients into two groups according to the involvement of AIH Stanford type A involved the ascending aorta and the aortic arch and accounted for 10 cases, whereas type B involved only the descending aorta and accounted for 20 cases. The data for the two groups were then compared. RESULTS: Of the 30 patients, the number of type B was twice that of type A. Of the 16 males in the study, 14 (88%) were type B. Almost all patients omplained of chest pain, back pain, or both, 80% had hypertension and 50% were smokers. Of the type A patients, 70% showed mediastinal widening on chest X-ray, which was confirmed by CT. According to the type of aortic wall thickness on CT, 50% were circular and 50% were crescentic. Complications included in 5 cases of pericardial effusion, of which 1 patient had a pericardial tamponade. Each 1 of these 5 patients progressed to aortic dissection and aortic rupture, after which they died. All patients except one took medical therapy, 2/3 of whom were followed up within at least one year. CONCLUSION: AIH is not a very common disease, but is often encountered in the ED. It 's a medical, not a surgical disease, but requires surgical therapy in cases of ascending aortic dissection or cardiac tamponade, and aortic rupture. Almost all patients with AIH can be diagnosed by emergency physicians using computerized tomography in the ED, so we think that it is very important to assess the patient's clinical status and complications, to monitor the patient carefully in the ED, and to make plans for follow-up.