Over the past few decades, various kinds of aortic pathologies mimicking
classic aortic dissection have been demonstrated on different imaging modalities.
“Acute aortic syndrome”, a new term, includes all these diseases. The most prevalent is
aortic intramural hematoma (IMH). In this uncommon and potentially fatal disease,
there is no intimal tear. Instead, hemorrhage within the media layer may lead to
subsequent communication with the true lumen. Although the prognosis for IMH seems
better than that for aortic dissection, survivors are still at risk for late adverse aortic
complications such as aneurysm formation, dissection, rupture, and ulceration. The
exact definition, prevalence, and outcomes for acute IMH continue to be debated.
Furthermore, its management, which varies from immediate surgery to medical
management only, remains controversial. The purpose of this review is therefore to
present and analyze the natural history and clinical presentation of acute type A IMH.
The various diagnostic modalities used and the management of type A IMH are also
reviewed, with an emphasis on the current controversies.
Keywords: Acute aortic syndrome, Adventitia, Aneurysm, Asian, Controversies,
Diagnosis, Imaging modalities, Immediate surgery, Intima, Intimal tear,
Intramural hematoma, IRAD, Magnetic resonance imaging, Management,
Medical management, Mortality, Pathogenesis, Type A dissection, Ulceration,
Western centers.
