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Aortic Intramural Haematoma — EECC MCQ

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ModerateAortic DiseaseAortic Intramural HaematomaEECC

A 72-year-old man presents with acute severe chest pain. CT aortography shows a crescent-shaped area of high attenuation within the aortic wall of the ascending aorta without an intimal flap or false lumen. What is the most likely diagnosis and recommended management?

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Correct answer: D — Aortic intramural haematoma (IMH) of the ascending aorta; emergency surgical repair as for type A dissection

Aortic intramural haematoma (IMH) is characterised by haemorrhage within the aortic wall without an intimal tear or false lumen, appearing as a crescent of high attenuation on CT. IMH involving the ascending aorta (type A IMH) is considered a surgical emergency with management equivalent to type A aortic dissection (Class I recommendation for emergency surgery). This is because type A IMH carries a similar risk of progression to frank dissection, rupture, and tamponade. Type B IMH (descending aorta) can initially be managed medically with close surveillance, analogous to uncomplicated type B dissection. The ESC Aortic Disease Guidelines classify IMH as part of the acute aortic syndrome spectrum.

Reference: ESC (2024): Guidelines for the Management of Peripheral Arterial and Aortic Diseases