Sudden onset chest pain after a CT-scan of the aorta
Fabienne E. Vervaat, Thomas van Brakel, Sjoerd Bouwmeester
Abstract
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Taxonomy
TopicsCardiac Imaging and Diagnostics · Pericarditis and Cardiac Tamponade · Infective Endocarditis Diagnosis and Management
Answer
Given the patient’s medical history, there was an immediate suspicion of type A aortic dissection. A new CT-scan was performed and a type A intramural hematoma (IMH) was diagnosed (Fig. 1). Type A IMH is recognized and differentiated from a type A aortic dissection by a crescentic or circular aortic wall thickening in the absence of an intimal flap [1]. IMH is the cause of acute aortic syndrome in 5–25% of the cases with ~30% involving the ascending aorta and in 12% of patients an IMH can evolve into an aortic dissection [1]. The current treatment for type A IMH is comparable to that of type A aortic dissection, which is surgery [1]. Emergency surgery was performed successfully, involving biological aortic valve replacement and hemi aortic arch replacement. The patient’s post-operative recovery was uneventful, and she was discharged after ten days. During the first outpatient follow-up two months later, the patient reported being symptom-free and recovering well.Fig. 1a, b CT-scan of the aorta after symptom onset showing an intramural hematoma located at the aortic root and ascending aorta
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