Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 May 7;30(9):103277.
doi: 10.1016/j.jaccas.2025.103277. Epub 2025 Feb 26.

Medical Treatment or Surgery for Type A Intramural Hematoma?

Faezeh Tabesh  1 , Mohsen Mirmohammadsadeghi  2 , Ali Nasri  1 , Mohammad Amini  3 , Mohammadsadegh Sahebzade  4
Affiliations
Case Reports

Medical Treatment or Surgery for Type A Intramural Hematoma?

Faezeh Tabesh et al. JACC Case Rep. .

Abstract

Background: Type A intramural hematoma (IMH) is a cardiovascular emergency with high mortality and morbidity rates. Emergency surgery remains the preferred management option.

Case summary: A 50-year-old woman was admitted with a chief complaint of chest pain and evidence of aortic dissection in transthoracic echocardiography. Computed tomographic angiography (CTA) showed IMH from the aortic root to the suprarenal arteries. In the absence of high mortality risk factors, medical treatment and follow-up studies were chosen for this patient. CTA was repeated at 3-month intervals for 1 year, and by the end of this period the IMH was completely resolved. WHY BEYOND THE GUIDELINES?: Guidelines recommend emergency surgical intervention for type A IMH. This report presents evidence of successful medical treatment for type A IMH.

Discussion: This case report showed that medical management with follow-up imaging studies can be considered as the first option in selected patients with type A IMH.

Keywords: acute aortic syndrome; aortic diseases; aortic dissection; aortic intramural hematoma; case reports.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Baseline Computed Tomographic Angiography The baseline computed tomographic angiography showed intramural hematoma of the ascending aorta (white arrows) and descending thoracic aorta (blue arrows). (A) Axial view; (B) coronal view; (C) sagittal view.
Figure 2
Figure 2
In-Hospital Follow-Up Computed Tomographic Angiography In-hospital follow-up computed tomographic angiography showed no change in ascending (white arrows) and descending (blue arrows) aorta intramural hematoma thickness and aorta size. (A) Axial view; (B) coronal view; (C) sagittal view.
Figure 3
Figure 3
Last Follow-Up Computed Tomographic Angiography The last computed tomographic angiography of the patient showed complete resolution of the intramural hematoma in the ascending aorta (white arrows) and descending thoracic aorta (blue arrows). (A) Axial view; (B) coronal view; (C) sagittal view.
Visual Summary
Visual Summary
Timeline of Events Depicting the Clinical Data of the Patient's Diagnosis, Treatment, and the Results of Imaging
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Banceu C.M., Banceu D.M., Kauvar D.S., et al. Acute aortic syndromes from diagnosis to treatment—a comprehensive review. J Clin Med. 2024;13(5):1231. doi: 10.3390/jcm13051231. - DOI - PMC - PubMed
    1. Muratori M., Mancini M.E., Tamborini G., et al. Approach to the patient with acute aortic syndromes in light of the new consensus statement on multimodality imaging in thoracic aortic diseases. J Cardiovasc Echogr. 2023;33(3):109–116. doi: 10.4103/jcecho.jcecho_36_23. - DOI - PMC - PubMed
    1. Sorber R., Hicks C.W. Diagnosis and management of acute aortic syndromes: dissection, penetrating aortic ulcer, and intramural hematoma. Curr Cardiol Rep. 2022;24(3):209–216. doi: 10.1007/s11886-022-01642-3. - DOI - PMC - PubMed
    1. Al Rstum Z., Tanaka A., Eisenberg S.B., Estrera A.L. Optimal timing of type A intramural hematoma repair. Ann Cardiothorac Surg. 2019;8(5):524–530. doi: 10.21037/acs.2019.07.08. - DOI - PMC - PubMed
    1. Yang J., Yu C., Li X., et al. Therapeutic management of acute type A aortic intramural hematoma. BMC Cardiovasc Disord. 2021;21(1):286. doi: 10.1186/s12872-021-02104-4. - DOI - PMC - PubMed

Publication types

LinkOut - more resources