<p>Diagnosing Aortic Intramural Hematoma: Current Perspectives</p>

Abstract

Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.

Aortic intramural hematoma and classic aortic dissection: two sides of the same coin within the acute aortic syndrome for an interventional radiologist

“…Aortic intramural haematomas (AIH) typically occur in older females with cardiovascular risk factors and usually involve the descending aorta. 1 Although traditionally considered the result of a haemorrhage of the vasa vasorum, AIH is now defined as a thrombosed aortic dissection. 2 Presenting symptoms such as chest or back pain are non-specific; so is elevated plasma D-dimer which, however, may also imply extension of a pre-existing AIH or dissection.…”

“…Computed tomography (CT) remains the gold-standard technique for diagnosis, follow-up and detection of complications. In addition, CT provides important prognostic information when measuring parameters like the maximum haematoma thickness (MHT) and the maximum aortic diameter (MAD) 1 or evaluating “ancillary findings”. 3 Drawbacks are high radiation-doses, contrast-induced nephrotoxicity and artefacts from motion or beam hardening.…”

“… 8,9 Thoracic endovascular aneurysm repair (TEVAR) may be performed with either curative or preventive purposes. In the first case, signs of impending AD like acute or significant intimal erosions or considerable aortic enlargement are considered 1 ; the second choice comes from the observation of a lowered aorta-related mortality. 7 The rationale of TEVAR is to exclude and favour the thrombosis of the false lumen; it seems that the earliest it is performed, the higher the likelihood of fully re-expansion of the true lumen.…”

“…Aortic intramural haematoma represents the result of a thrombosed aortic dissection. 1 A haemorrhage of the vasa vasorum was traditionally advocated, and many authors have recently proposed a role in the genesis of those AIH with no visible “tears”. 2 It shows a marked predilection for old females with cardiovascular risk factors and mostly affects the descending aorta (Stanford type B).…”

“…It also has an important prognostic role when measuring MHT, MAD and ulcer-like projections (ULPs), predicting a worse prognosis when over 11 mm, 50 mm (in width) and 10 mm (in depth), respectively. 1 Ancillary findings like pleural or pericardial effusions, periaortic and mediastinal fat stranding within the first 24 h seem associated with poor outcomes. Finally, CT is employed for follow-up and potential complications.…”