Intramural Hematoma and Penetrating Ulcers: Indications to Endovascular Treatment

Eggebrecht, Holger; Plicht, Björn; Kahlert, Philipp; Erbel, Raimund

doi:10.1016/j.ejvs.2009.09.001

Cited by 152 publications

(134 citation statements)

References 21 publications

(34 reference statements)

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“…PAUs are intimately associated with atherosclerosis of the aorta (35). The vast majority is located in the descending thoracic aorta (85-95%) and is much less common in the ascending aorta and arch (36)(37)(38)(39)(40)(41). There is an association of PAU with the term "IMH" since there can be concomitant hematoma within the media which may portend a higher risk of aortic complication (41).…”

Section: Penetrating Aortic Ulcer (Pau)mentioning

confidence: 99%

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Acute aortic syndrome

Corvera

2016

Ann. Cardiothorac. Surg.

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Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another.

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Section: Penetrating Aortic Ulcer (Pau)mentioning

confidence: 99%

“…PAUs account for 2-7% of AAS (36) and may be the least understood of the triad. PAUs are intimately associated with atherosclerosis of the aorta (35).…”

Section: Penetrating Aortic Ulcer (Pau)mentioning

confidence: 99%

Acute aortic syndrome

Corvera

2016

Ann. Cardiothorac. Surg.

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“…21,22) The PAU was originally described as 'an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina', not unlike a peptic ulcer on imaging. 23) In comparison, IMH is a bleeding within the walls of the aorta without an intimal tear, presumably as a result of rupture from the vaso vasora.…”

Section: Penetrating Aortic Ulcermentioning

confidence: 99%

Thoracic Endovascular Aortic Repair-indications and Evidence

Cao

Bannon

Shee

et al. 2011

ATCS

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“…Patients with type A IMH with PAU should have early surgery, if possible, since they are at high risk for dissection, rupture, aortic regurgitation, cardiac tamponade, or myocardial infarction. PAU accounts for 2-7 % of symptomatic patients with suspected acute aortic syndrome, and an IMH can be identified in approximately 6 % of aortic dissections [2,3]. Noncontrast enhanced CT scan with a high attenuation crescent sign…”

mentioning

confidence: 99%

Type A intramural hematoma and hemopericardium secondary to penetrating atherosclerotic ulcer

et al. 2015

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A 65-year-old woman presented with syncope after having breakfast. She reported dizziness and blackout like symptoms before the syncope episode; however, the neurologic examination showed no evidence of hemiplegia or other neurologic residue. The brain computed tomography (CT scan) revealed no evidence of intracranial hemorrhage or stroke lesion. The patient collapsed with presentation of shock and altered consciousness 2 h after arriving at the emergency department. The physical examination revealed hypotension and engorged jugular veins. Emergent wholebody CT scan was performed, and the noncontrast-enhanced CT scan showed a high attenuation crescent sign in the ascending aortic wall consistent with an intramural hematoma (IMH), and filling of the pericardium consistent with an intramural hemopericardium (Fig. 1a). Contrastenhanced CT scan demonstrated low attenuation of the ascending aortic wall and a penetrating atherosclerotic ulcer (PAU) in the aortic root (Fig. 1b). The patient received emergent ascending aorta grafting surgery. The postoperative period was uneventful, and the patient recovered well.IMH with PAU of aorta are included in the acute aortic syndromes as aortic dissection variants. IMH and aortic dissection share similar risk factors, and are classified the same way as Stanford type A and type B. Ascending aorta IMH may cause aortic regurgitation, hemopericardium or aortic rupture. Predictors of adverse outcomes include syncope, enlarged aorta diameter ([55 mm) and increased hematoma thickness ([16 mm) [1]. PAU often has a variable degree of IMH. Patients with type A IMH with PAU should have early surgery, if possible, since they are at high risk for dissection, rupture, aortic regurgitation, cardiac tamponade, or myocardial infarction. PAU accounts for 2-7 % of symptomatic patients with suspected acute aortic syndrome, and an IMH can be identified in approximately 6 % of aortic dissections [2,3]. Noncontrast enhanced CT scan with a high attenuation crescent sign

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Intramural Hematoma and Penetrating Ulcers: Indications to Endovascular Treatment

Cited by 152 publications

References 21 publications

Acute aortic syndrome

Acute aortic syndrome

Thoracic Endovascular Aortic Repair-indications and Evidence

Type A intramural hematoma and hemopericardium secondary to penetrating atherosclerotic ulcer

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