Aortic intramural hematoma

Case contributed by Dr Sachintha Hapugoda

Presentation

Acute central chest and bilateral jaw pain. Progressive with generalized weakness. History of hypertension and ischemic heart disease.

Patient Data

Age: 80 years
Gender: Male

Chest XR

X-ray

Prominence of the aortic knuckle with focal widening of the mediastinum is present. 

CT

Ectasia of ascending thoracic aorta is present, extending 10 cm from the aortic root to the aortic isthmus. There is thickening and hyperattenuation of the ascending aortic wall. Nil evidence of contrast extravasation from the aortic lumen. Nil dissection flap seen.

Conclusion: Acute aortic intramural hematoma (Stanford Type A)

Case Discussion

The patient successfully underwent emergency open repair of the hematoma. Findings were consistent with a type A intramural hematoma extending from the non-coronary sinus to the mid-aortoc arch.

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