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Mini-symposium
Aortic intramural haematoma: current therapeutic strategy
  1. M D Dake
  1. Correspondence to:
    Michael D Dake, MD
    Stanford University School of Medicine, Room H3647, 300 Pasteur Drive, Stanford, CA 94305, USA; mddakestanford.edu

https://doi.org/10.1136/hrt.2003.027631

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    Over the last 10 years, intramural haematoma (IMH) of the aorta has become increasingly recognised as a pathological entity distinct from aortic dissection.1 Despite this enhanced appreciation and the resultant increase in the frequency of its diagnostic identification, a consensus regarding optimal management strategies for this disease has not been established.2 This is due in part to our incomplete understanding of a condition only first clearly established in the mid 1980s. As opposed to aortic dissection where we have developed a relatively comprehensive knowledge of the more common constellations of anatomic involvement and their clinical outcomes, with IMH we are now only at a stage of correlating insights gleaned from clinical series contributed by investigators from around the world.1–,14 Many of theses observations have been presented in the prior discussions.

    MANAGEMENT STRATEGIES

    As the profile of clinical factors, imaging findings, acute outcomes, and long term results of various management strategies comes into sharper focus, some patterns are emerging and serve as a basis for establishing the initial standard treatment algorithms for IMH. One of the aspects of IMH, however, that confounds attempts to set indications for intervention, much less precise management techniques, is the wide variety of morphologic appearances of aortic IMH observed with common diagnostic imaging modalities, including transoesophageal echo (TOE) or magnetic resonance imaging/computed tomographic (MRI/CT) scans. Traditionally, IMH refers to haemorrhage contained within the medial layer of the aortic wall, and is distinguished from typical aortic dissection and penetrating atherosclerotic aortic ulcer by the absence of an associated tear in the intima or direct communication between the media and the aortic lumen.

    Unfortunately, this seemingly straightforward differentiation is not always possible because of the rapid tempo of morphologic evolution noted frequently on sequential imaging exams of patients with IMH. Thus, depending on the exact …

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