Images in Clinical Medicine
Aortic Intramural Hematoma
N Engl J Med 1997; 336:1875June 26, 1997
- Article
A 77-year-old woman with a history of hypertension and an abdominal aortic aneurysm presented with acute upper back discomfort. The physical examination on admission was unremarkable, and a chest film revealed dilatation of a tortuous thoracic aorta. Transesophageal echocardiography (Panel A) showed severe atherosclerosis of a mildly enlarged descending aorta. There was eccentric thickening of one wall of the aorta (arrowhead) that was consistent with thrombus or intramural hematoma. A computed tomographic (CT) scan confirmed these findings. The patient was treated with aggressive blood-pressure control but had recurrent back discomfort, and another CT scan (Panel B) suggested enlargement of the descending aorta (arrowhead). Aortography was performed and showed no evidence of dissection but did reveal an ectatic descending aorta with a penetrating aortic ulcer on the lateral aspect (arrowhead, Panel C). At surgery the descending aorta was found to be markedly enlarged, discolored, and aneurysmal. There was severe atherosclerosis of the descending aorta, with a penetrating aortic ulcer and hematoma within the aortic wall (Panel D). The patient underwent graft repair of both the descending aorta and the abdominal aneurysm. Paraplegia developed postoperatively, and after a prolonged hospitalization the patient was discharged to an extended-care facility.
Kevin M. Harris, M.D.
Washington University School of Medicine, St. Louis, MO 63110Michael Rosenbloom, M.D.
Memorial Regional Heart Center, Hollywood, FL 33021- Citing Articles (2)
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