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.