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Aortic intramural haematoma: remarks and conclusions
  1. A Evangelista
  1. Correspondence to:
    A Evangelista, MD
    FESC, Servei de Cardiologia, Hospital Vall d’Hebron, P° Vall D’Hebron 119, 08035 Barcelona, Spain;

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Aortic intramural haematoma (IMH) originates from spontaneous rupture of the aorta vasavasorum or from a penetrating atherosclerotic ulcer. Recent advances in imaging techniques have significantly aided its diagnosis, placing the incidence between 10–30% of acute aortic syndromes. Clinical presentation may be identical to that of classical dissection. IMH affects patients with more atherosclerotic risk factors and older age than aortic dissection, and it is located in the descending aorta in 60–70% of cases.


Although the diagnostic sensitivity seems to be similar among computed tomography (CT), magnetic resonance imaging (MRI), and transoesophageal echocardiography (TOE), the diagnosis of IMH is more complex than that of classical dissection, with at least two diagnostic techniques being performed in most cases. In the International Registry of Aortic Dissection, the CT–TOE combination was the most used. Nevertheless, MRI has the advantage of permitting detection of new bleeds in the aorta wall, which may be important in subacute and chronic phases.

Imaging techniques …

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