Clinical Presentation, Diagnosis, and Management of Type A Aortic Intramural Hematoma: Update, Controversies, and Unknowns

Over the past few decades, various kinds of aortic pathologies mimicking classic aortic dissection have been demonstrated on different imaging modalities. “Acute aortic syndrome”, a new term, includes all these diseases. The most prevalent is aortic intramural hematoma (IMH). In this uncommon and potentially fatal disease, there is no intimal tear. Instead, hemorrhage within the media layer may lead to subsequent communication with the true lumen. Although the prognosis for IMH seems better than that for aortic dissection, survivors are still at risk for late adverse aortic complications such as aneurysm formation, dissection, rupture, and ulceration. The exact definition, prevalence, and outcomes for acute IMH continue to be debated. Furthermore, its management, which varies from immediate surgery to medical management only, remains controversial. The purpose of this review is therefore to present and analyze the natural history and clinical presentation of acute type A IMH. The various diagnostic modalities used and the management of type A IMH are also reviewed, with an emphasis on the current controversies.

Keywords: Acute aortic syndrome, Adventitia, Aneurysm, Asian, Controversies, Diagnosis, Imaging modalities, Immediate surgery, Intima, Intimal tear, Intramural hematoma, IRAD, Magnetic resonance imaging, Management, Medical management, Mortality, Pathogenesis, Type A dissection, Ulceration, Western centers.