title: Thickening of the pulmonary artery wall in acute intramural hematoma of the ascending aorta.
abstract: BACKGROUND
  The occurrence of pulmonary artery obstruction in the course of acute aortic dissection is an unusual complication. The mechanism implicated is the rupture of the outer layer of the aorta and the subsequent hemorrhage into the adventitia of the pulmonary artery that causes its wall thickening and, at times, produces extrinsic obstruction of the vessel. There are no reports of this complication in acute intramural hematoma.
  
  
  METHODS
  An 87-year-old woman was admitted to the hospital in shock after having had severe chest pain followed by syncope. An urgent transesophageal echocardiogram revealed the presence of acute intramural hematoma, no evidence of aortic dissection, severe pericardial effusion with cardiac tamponade, and periaortic hematoma that involved the pulmonary artery generating circumferential wall thickening of its trunk and right branch with no evidence of flow obstruction. Urgent surgery was performed but the patient died in the operating room. The post mortem examination, in the operating room, confirmed that there was an extensive hematoma around the aorta and beneath the adventitial layer of the pulmonary artery, with no evidence of flow obstruction.
  
  
  CONCLUSIONS
  This is the first time that this rare complication is reported in the scenario of acute intramural hematoma and with the transesophageal echocardiogram as the diagnostic tool.
authors.affiliation: Department of Echocardiography, CEMIC, Hospital Universitario Saavedra, Av, E, Galván 4102 Capital Federal Buenos Aires C1431FWO, Argentina. mmunin@gmail.com
authors.forename: Martín
authors.initials: M
authors.lastname: Munín
authors.forename: María S
authors.initials: MS
authors.lastname: Goerner
authors.forename: Martín
authors.initials: M
authors.lastname: Lombardero
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sanchez
authors.forename: Juan C Pereira
authors.initials: JC
authors.lastname: Redondo
authors.forename: Fernando
authors.initials: F
authors.lastname: Spernanzoni
authors.forename: Héctor
authors.initials: H
authors.lastname: Lardani
authors.forename: Víctor
authors.initials: V
authors.lastname: Torres
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology*