Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis.
BACKGROUND
Advances in imaging techniques have increased the recognition of aortic intramural hematomas (IMHs) and penetrating atherosclerotic ulcers (PAUs); however, distinction between IMH and PAU remains unclear. We intended to clarify differences between IMH coexisting with PAU and IMH not associated with PAU by comparisons of clinical features, imaging findings, and patient outcome to derive the optimal therapeutic approach.


RESULTS
We performed a retrospective analysis of 65 symptomatic patients with aortic IMH. There were 34 patients with IMH associated with PAU (group 1) and 31 patients with IMH unaccompanied by PAU (group 2). Involvement of the ascending aorta (type A) was more frequent in group 2 (8 of 31, 26%), whereas most of the patients in group 1 had exclusive involvement of the descending aorta (type B) (31of 34, 91%). Patients were subdivided into 2 categories, those with clinical progression and those with stable disease. Forty-eight percent of patients in group 1 and 8% in group 2 were in the progressive category (P=0.002). Clinical and radiological findings were compared between those group 1 patients who had a progressive disease course (n=12) and those who were stable (n=13). Sustained or recurrent pain (P<0.0001), increasing pleural effusion (P=0.0003), and both the maximum diameter (P=0.004) and maximum depth (P=0.003) of the PAU were reliable predictors of disease progression.


CONCLUSIONS
This study suggests a difference in disease behavior that argues for the prognostic importance of making a clear distinction between IMH caused by PAU and IMH not associated with PAU. IMH with PAU was significantly associated with a progressive disease course, whereas IMH without PAU typically had a stable course, especially when limited to the descending thoracic aorta.
Division of Cardiovascular and Interventional Radiology, Stanford University School of Medicine, Stanford, Calif 94305, USA.
Fumikiyo
F
Ganaha
D Craig
DC
Miller
Koji
K
Sugimoto
Young Soo
YS
Do
Hiroki
H
Minamiguchi
Haruo
H
Saito
R Scott
RS
Mitchell
Michael D
MD
Dake
D001018:Aortic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D001161:Arteriosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014456:Ulcer / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy