Mild thickening of the aortic wall: subtle intramural hematoma?
Recently published criteria for the diagnosis of intramural hematoma (IMH) of the ascending aorta by transesophageal echocardiogram (TEE) include the presence of a crescent-shaped thickening of the aortic wall of more than 7 mm with an echolucent space. We report a patient whose clinical presentation suggested aortic dissection but whose TEE failed to meet the conventional criteria for such a diagnosis. TEE showed a uniform intimal thickening suspicious of IMH but less than 7 mm in thickness and with no echofree space. One week later, the patient developed frank aortic dissection.


CONCLUSIONS
IMH can present with a subtle echo appearance. The diagnosis should not be totally discounted in the absence of a 7-mm crescentic wall thickness and an echofree space if the clinical presentation is suggestive of dissection.
Mansour
M
M
Department of Cardiology, Crouse Hospital, 736 Irving Avenue, Syracuse, NY 13210, USA.
Berkery
W
W
Kozlowski
L
L
Widell
J
J
Obeid
A
A
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans