title: Intramural aortic hematoma: no flap no warning?
abstract: We report a case of type A intramural aortic hematoma (IMH) occurred in a 78 years old female. The clinical scenario (medical history of hypertension, severe substernal chest pain, early diastolic decrescendo murmur as for aortic insufficiency), the laboratory results (no significant troponin level), ECG and transthoracic echocardiography findings (no signs of myocardial ischemia) shifted the initial diagnostic suspicion from acute coronary syndrome to the acute aortic syndrome (AAS) and triggered further imaging tests. Computed tomography revealed an aneurismatic dilatation with thickening of the wall of the ascending aorta without intimal flap. No particular "warning message" for evidence of AAS was sent to the clinician on call. Subsequently, due to the persisting high clinical suspicion transesophageal echocardiography (TEE) was performed. TEE confirmed the aneurysm of the ascending aorta and highlighted an extended and marked aortic wall thickness, consisting with the diagnosis of type A IMH. Patient underwent urgent cardiac surgery that confirmed the diagnosis.
authors.affiliation: Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy. rodolfocitro@teletu.it
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Antonello
authors.initials: A
authors.lastname: Panza
authors.forename: Paolo
authors.initials: P
authors.lastname: Masiello
authors.forename: Amelia
authors.initials: A
authors.lastname: Ravera
authors.forename: Lucia
authors.initials: L
authors.lastname: Tedesco
authors.forename: Rocco
authors.initials: R
authors.lastname: Leone
authors.forename: Marco
authors.initials: M
authors.lastname: Mirra
authors.forename: Roberta
authors.initials: R
authors.lastname: Giudice
authors.forename: Severino
authors.initials: S
authors.lastname: Iesu
authors.forename: Francesco
authors.initials: F
authors.lastname: Silvestri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Benedetto
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis* / Q000601:surgery; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000601:surgery; D006801:Humans