Intramural Hemorrhage of the Thoracic Aorta

Abstract

IMH is associated with a clinical profile and prognosis similar to classic dissection and may be considered an ominous precursor of overt aortic dissection. Tomographic noninvasive imaging ensures rapid, nontraumatic diagnosis of IMH. The outcome of IMH of the ascending aorta appears favorable only with immediate surgical repair.

Intramural hematoma of the aorta: predictors of progression to dissection and rupture

“…Initial tomographic imaging was performed by random use of transesophageal echocardiography (TEE), contrastenhanced x-ray computed tomography (CT), and MRI. All cases with IMH on initial images were confirmed by additional tomographic modalities 1,[12][13][14] ; discordant diagnostic findings were resolved by a third independent imaging procedure in 7 patients. Imaging was completed within 24 hours of hospital admission.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, progression of IMH both to overt dissection and rupture of the aorta is unpredictable, and strategies for therapeutic management are not established. For instance, whereas blood pressure control using ␤-adrenergic receptor blockers is widely accepted for treating IMH, surgical repair of proximal IMH (type A) is not yet recognized as therapeutic standard for prevention of serious complications.…”

“…For instance, whereas blood pressure control using ␤-adrenergic receptor blockers is widely accepted for treating IMH, surgical repair of proximal IMH (type A) is not yet recognized as therapeutic standard for prevention of serious complications. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Thus, this multicenter study was conducted to assess predictors of progression both early and late after diagnosis of IMH.…”

Diretrizes para a cirurgia das doenças da aorta

“…De modo geral, pode-se considerá-lo uma condição tão potencialmente catastrófica quanto a DAA e inferir que a mortalidade seja significativa -20 a 80% [114][115][116] , que a evolução para dissecção verdadeira deva ocorrer em 15 a 41% dos casos [117][118][119][120] , a ruptura em 5 a 26% dos pacientes, e a evolução para cura espontânea, de forma variável 121,122 . Em um levantamento prospectivo recente de 360 casos de dissecções aórticas agudas, Nienaber e cols.…”

“…Em um levantamento prospectivo recente de 360 casos de dissecções aórticas agudas, Nienaber e cols. 117 observaram que 25 (12%) apresentavam falsa luz evidente, porém sem Tabela II -Recomendações para o tratamento das dissecções agudas tipo B.…”