Aortic Intramural Hematoma: Diagnosis, Treatment, and Evolution

Aortic intramural hematoma has been considered a precursor of overt aortic dissection1,2; however, the pathophysiologic mechanism, evolution, and prognosis are rather different from those of classical dissection. Advances in imaging techniques have facilitated diagnosis and have aided understanding of the natural history of this entity, practically unknown 10 years ago. Aortic intramural hematoma (IMH) is an entity included in the acute aortic syndrome (AAS) together with aortic dissection and penetrating aortic ulcer3. While, in classical aortic dissection, flow communication occurs though a primary intimal tear and blood propagation creates a false lumen, in intramural hematoma hemorrhage occurs within the aortic wall in the absence of intimal disruption4,5.