Type A intramural haematoma secondary to penetrating atherosclerotic ulcer of the ascending aorta

Abstract

Intramural haematoma and penetrating atherosclerotic ulcer belong to the group of acute aortic syndromes. The combined presentation of both intramural haematoma and a penetrating atherosclerotic ulcer in the ascending aorta is a very rare finding. Here, we present the case of a 72-year-old female, who was admitted to our centre with acute chest and back pain. She was diagnosed with type A intramural haematoma secondary to a penetrating atherosclerotic ulcer of the ascending aorta, and she underwent subsequent emergent surgical management. The diagnosis was confirmed intraoperatively and histopathologically. This case depicts the dynamic pathophysiological development of acute aortic syndromes and the finding that different entities of acute aortic syndromes may evolve or lead to another.

Late Presentation of Penetrating Ulcers at the Ascending Aorta Associated With Intra-Mural Haematoma

“…The pathogenesis of IMH combined with PAU may lead to further progression, namely rupture or pseudoaneurysm [5] and hence surgical intervention should be prompt (3).In this case, despite the absence of typical symptoms, offering surgical intervention was deemed necessary based on the absence of patient co-morbidities and the association of IMH with PAU, which increased the likelihood of complications.…”

“…There is guidance for chronic dissection and non-leaking aneurysm based on size criteria, rate of expansion of the aorta or the presence of symptoms. There is, however, a lack of guidance and evidence for the management of chronic IMH and PAU of the ascending aorta due to the rarity of these cases [3]. Reports in the literature are mostly on the descending aorta, which is the most common site for IMH and PAU with the management being essentially conservative unless the patient is symptomatic, the aorta grows to a concerning size or ruptures [4].…”