Recently the concept of acute aortic syndromes has encompassed a range of pathological changes in the wall of the aorta leading to a myriad of clinical presentations, all of which are not only worrying to the patient, but can be a doctor's nightmare! One particular type of acute aortic syndrome (which you may remember includes aortic dissection) is IMH - Intramural Hematoma.
Intramural hematomas are preceded by atherosclerotic plaques. In fact, over time, atherosclerotic plaques in the proximal aorta can develop penetrating ulcers. These eventually invade the vasa vasorum lining the tunica media, and result in bleeding. The blood accumulates in the wall of the aorta in a characteristic crescentic shape. It is important to keep in mind that IMH does not involve the tunica intima, which is the site of involvement in aortic dissection. In other words, there is no intimal flap.
Common symptoms include chest pain and interscapular pain. Neurological and vascular complications may occur, but are rare.
Over time, IMH may lead to aortic dissection. Diagnosis can be made by echocardiography, though CT would provide more information. MRI is also useful.
Surgical treatment is required. IMH carries a high mortality so requires prompt treatment.
Key points for MRCP regarding IMH
1. No intimal flap
2. Can progress to aortic dissection
3. CT is a good test, MRI is useful as well.
4. Prompt surgical treatment is required.
Here is a good review.
Intramural hematomas are preceded by atherosclerotic plaques. In fact, over time, atherosclerotic plaques in the proximal aorta can develop penetrating ulcers. These eventually invade the vasa vasorum lining the tunica media, and result in bleeding. The blood accumulates in the wall of the aorta in a characteristic crescentic shape. It is important to keep in mind that IMH does not involve the tunica intima, which is the site of involvement in aortic dissection. In other words, there is no intimal flap.
Common symptoms include chest pain and interscapular pain. Neurological and vascular complications may occur, but are rare.
Over time, IMH may lead to aortic dissection. Diagnosis can be made by echocardiography, though CT would provide more information. MRI is also useful.
Surgical treatment is required. IMH carries a high mortality so requires prompt treatment.
Key points for MRCP regarding IMH
1. No intimal flap
2. Can progress to aortic dissection
3. CT is a good test, MRI is useful as well.
4. Prompt surgical treatment is required.
Here is a good review.
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