Aortic intramural hematoma with rupture and concomitant acute myocardial infarction: diagnostic and therapeutic dilemmas

Aortic Intramural Hematoma and Its Complications

“…7,9 The symptoms and signs can also be caused by complications of IMH, including classic aortic dissection, pericardial effusion with tamponade, acute aortic regurgitation, hemothorax/ pleural effusion, acute neurological deficits, pulse deficits, acute myocardial infarction, and rupture or dissection. [2][3][4][5][6][7][8][9][10] Patients with IMH are at higher risk than patients with acute aortic dissection for developing periaortic hematoma and hemorrhagic pericardial effusion but are less likely than patients with acute aortic dissection to develop aortic regurgitation and acute coronary insufficiency.…”

“…Consequently, these patients have high rates of periaortic hematoma, pericardial effusion, and rupture in the mediastinum. [2][3][4][5]8,9,11,12 Periaortic hematoma can be caused by oozing of blood or frank rupture in the pericardial sac or mediastinum. Bleeding from the intrapericardial portion of the ascending aorta will immediately result in a hemorrhagic pericardial effusion, whereas bleeding from the extrapericardial portion of the aorta will result initially in bleeding in the mediastinum and pleural cavity, leading to hemorrhagic pleural effusion.…”

“…3,5,8 PAU accounts for 2% to 7% of acute aortic syndromes, with a rupture rate as high as 38% in patients with PAUs presenting as acute aortic syndrome.…”

“…The possible mechanisms of myocardial infarction in IMH, which may be similar to acute dissection, include type A, coronary compression; type B, retrograde dissection; type C, coronary artery detachment; in situ thrombosis. 8 Recognition of acute coronary syndrome in IMH is important, because primary coronary intervention and thrombolytic therapy are contraindicated in these patients. …”