Key Clinical Message
Acute type A small intramural hematoma should be aware of fatal
complications.
The treatment of acute type A intramural hematoma (IMH) has been
controversial. It is reported that initial medical treatment with blood
pressure and pain control and repetitive imaging may be a reasonable
option, particularly in the absence of aortic dilation (<50
mm) and IMH thickness <11 mm1). A
71-year-old woman was admitted to the hospital due to cardiac tamponade.
Computed tomography revealed that the diameter and wall thickness of the
ascending aorta was 36 mm and 9 mm, respectively, indicating type A
intramural hematoma [Fig. (A, B)]. An emergency surgery was
performed, but it resulted in uneventful outcomes [Fig. (C, D, E)].
The pathological findings indicated frank rupture of intramural hematoma
[Fig. (F)]. Acute type A small IMH is rare; however, physicians
should be aware of this possible complication.