title: Surgical treatment of intramural hematoma of the ascending aorta.
abstract: BACKGROUND
  Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection.
  
  
  METHODS
  A 65-year-old woman was admitted to our clinic for the second time, after her symptoms of chest pain and vertigo (with no electrocardiographic signs of myocardial infarction) hadn't disappeared after several months of medicament treatment (indicated in the first hospitalization). Computed tomography arteriography of the aorta showed no sign of acute aortic dissection, but revealed a contrast depo in the aortic wall of 8 x 14 mm dimensions, with no extravasation of contrast. Also, massive pericardial effusion was observed (10-30 mm in thickness). Transesophageal echocardiography confirmed these findings completely. The patient underwent surgery, in which plaque exulceration was detected on the convex side of the ascending aorta, 3 cm above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A resection of the ascending aorta was performed, and the aorta was reconstructed with a 30 mm Dacron tube graft. The patient was discharged on the 14th postoperative day with satisfactory results.
  
  
  CONCLUSIONS
  Intramural hematoma is not a common event, but it is potentially a fatal one. Open surgery in patients with an intramural hematoma is an effective treatment strategy, although percutaneous endovascular treatment options are being described.
authors.forename: Stamenko
authors.initials: S
authors.lastname: Susak
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Redzek
authors.forename: Vladimir
authors.initials: V
authors.lastname: Torbica
authors.forename: Jovan
authors.initials: J
authors.lastname: Rajić
authors.forename: Mirko
authors.initials: M
authors.lastname: Todić
mesh_terms: D000368:Aged; D000792:Angiography; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014651:Vasa Vasorum