Precipitous Resolution of Type-A Intramural Hematoma with Medical Management in a Patient with Metastatic Stage 4 Renal Cell Carcinoma

Abstract

Intramural hematoma (IMH) is a variant form of aortic dissection characterized by involvement of the aortic media without the presence of an overt intimal flap. Surgical extirpation is the standard of care for type-A IMH in the Western world. However, a conservative approach with anti-impulse therapy has been advocated especially in Japan as a viable alternative. Here, we report a case of an elderly male patient with a history of metastatic stage 4 renal cell carcinoma who was treated with anti-impulse therapy for an acute type-A IMH. Blood pressure stabilization and continuous monitoring resulted in complete resolution of the IMH within 6 days. This report illustrates how immediate medical management in patients with acute type-A IMH who are not surgical candidates can alleviate the progression or even lead to regression as early as 1 week after initiating anti-impulse therapy.

Successful Conservative Treatment of a Type A Aortic Intramural Hematoma

“…In addition, local radiographic expertise could provide us with reliable follow-up imaging and early recognition of adverse radiological features. To our knowledge, this is one of the few cases of rapid type A IMH resorption; 2 patients have been reported demonstrating extremely early resolution within 2 days, but in the context of active malignancy and its concomitant hypercoagulability effects ( 9 , 10 ).…”