title: Acute aortic intramural hematoma presenting with painless recurrent syncope.
abstract: A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.
authors.affiliation: Airedale General Hospital, West Yorkshire, UK. jcdro16@gmail.com
authors.forename: Jan
authors.initials: J
authors.lastname: Droste
authors.forename: Heidar Zafarani
authors.initials: HZ
authors.lastname: Zadeh
authors.forename: Mohammed
authors.initials: M
authors.lastname: Arif
authors.forename: Ian
authors.initials: I
authors.lastname: Craig
authors.forename: A K
authors.initials: AK
authors.lastname: Thakur
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology; D008297:Male; D012008:Recurrence; D018570:Risk Assessment; D013575:Syncope / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome