# Left Atrial Compression by an Intramural Hematoma: A Rare Case of Obstructive Shock

## TL;DR

An 85-year-old woman developed obstructive shock due to a rare case of left atrial compression caused by an enlarging aortic intramural hematoma.

## Contribution

Highlights a rare clinical scenario where an intramural hematoma leads to left atrial compression and obstructive shock.

## Key findings

- An intramural hematoma increased from 3.5 cm to 8 cm in diameter over 17 days.
- Transthoracic echocardiography identified left atrial compression and inflow obstruction.
- Obstructive shock was caused by extrinsic compression from the hematoma.

## Abstract

A 3.5 cm diameter descending aorta focal aneurysm was incidentally found when a computed tomography (CT) was conducted due to persistent pyrexia in an 85-year-old woman hospitalized for a non-obstructive urinary tract infection. Ten days later, whilst fever subsided and inflammation markers decreased, she became hypoxic. CT revealed an aortic intramural hematoma (Stanford type B) increasing the diameter of the thoracic aorta aneurysm to 6.5 cm. A thoracic endovascular aortic repair (TEVAR) surgery was performed. Seven days after the operation she developed respiratory and hemodynamic compromise. CT depicted further enlargement of the aortic intramural hematoma, increasing the aortic diameter to 8 cm. Transthoracic echocardiography provided valuable information showing extrinsic compression of the left atrium and left ventricle inflow obstruction provoking obstructive shock.