Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: A clinical and radiological analysis

Fumikiyo Ganaha, D. Craig Miller, Koji Sugimoto, Young Soo Do, Hiroki Minamiguchi, Haruo Saito, R. Scott Mitchell, Michael D. Dake

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343 Scopus citations

Abstract

Background - Advances in imaging techniques have increased the recognition of aortic intramural hematomas (IMHs) and penetrating atherosclerotic ulcers (PAUs); however, distinction between IMH and PAU remains unclear. We intended to clarify differences between IMH coexisting with PAU and IMH not associated with PAU by comparisons of clinical features, imaging findings, and patient outcome to derive the optimal therapeutic approach. Methods and Results - We performed a retrospective analysis of 65 symptomatic patients with aortic IMH. There were 34 patients with IMH associated with PAU (group 1) and 31 patients with IMH unaccompanied by PAU (group 2). Involvement of the ascending aorta (type A) was more frequent in group 2 (8 of 31, 26%), whereas most of the patients in group 1 had exclusive involvement of the descending aorta (type B) (31 of 34, 91%). Patients were subdivided into 2 categories, those with clinical progression and those with stable disease. Forty-eight percent of patients in group 1 and 8% in group 2 were in the progressive category (P=0.002). Clinical and radiological findings were compared between those group 1 patients who had a progressive disease course (n=12) and those who were stable (n=13). Sustained or recurrent pain (P<0.0001), increasing pleural effusion (P=0.0003), and both the maximum diameter (P=0.004) and maximum depth (P=0.003) of the PAU were reliable predictors of disease progression. Conclusions - This study suggests a difference in disease behavior that argues for the prognostic importance of making a clear distinction between IMH caused by PAU and IMH not associated with PAU. IMH with PAU was significantly associated with a progressive disease course, whereas IMH without PAU typically had a stable course, especially when limited to the descending thoracic aorta.

Original languageEnglish (US)
Pages (from-to)342-348
Number of pages7
JournalCirculation
Volume106
Issue number3
DOIs
StatePublished - Jul 16 2002

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Keywords

  • Aorta
  • Atherosclerosis
  • Imaging
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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