Aortic intramural hematoma (IMH) is a condition characterized by bleeding within the wall of the aorta without an entrance tear
Risk factors
- Age: Older age is a significant risk factor for the progression of IMH
- Ulcer-like projection: The appearance of an ulcer-like projection is a strong predictor of progression in patients with IMH
- Aortic diameter: A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications
- Echolucency: Evolution to dissection is related to echolucency
- Atherosclerotic ulcerated plaque: Absence of atherosclerotic ulcerated plaque is associated with evolution to aortic aneurysm
Clinical manifestations
- Pain: Patients with IMH often present with sudden, severe, and persistent chest or back pain
- Pericardial effusion: Patients with type A IMH are more likely to have pericardial effusion
- Periaortic hematoma: Patients with IMH are more likely to have periaortic hematoma
Prognosis
- Mortality rate: The prognosis of IMH can vary based on factors such as the extent and location of the hematoma. It usually carries a lower mortality rate than aortic dissection
- Progression: IMH evolves very dynamically in the short term to regression, dissection, or aortic rupture
- Long-term outcomes: The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one-third of cases, and progression to classical dissection is less common
In conclusion, aortic IMH is a serious condition with specific risk factors and clinical manifestations. Its prognosis can vary, with potential progression to more severe conditions such as aortic dissection or rupture. Regular surveillance and appropriate management are crucial in managing this condition