title: Clinical significance of echo-free space detected by transesophageal echocardiography in patients with type B aortic intramural hematoma.
abstract: To evaluate the prevalence and clinical significance of echo-free space (EFS) in aortic intramural hematoma (AIH) during transesophageal echocardiography (TEE), TEE performed during the acute phase in 71 consecutive patients with type B AIH was reviewed. Forty-four patients (62%) had EFS including 24 patients with a large EFS occupying >1/2 of the hematoma thickness. Among 59 patients who also underwent computed tomography, focal contrast enhancement in the hematoma area was observed in only 7 patients with a large EFS. Hospital mortality and incidence of surgical intervention in patients with EFS were 0% and 2%, respectively, which was similar to 4% in those without EFS. Follow-up imaging studies in 57 patients (80%) revealed development of typical aortic dissection (AD) in 6 patients and complete resorption of hematoma in 35; the incidence of either the development of AD or a complete resorption of hematoma was not significantly different between those with and without EFS. EFS by TEE is not rare in patients with type B AIH. It is not a poor prognostic factor and is not associated with the development of AD.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Jae Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seong Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed